Written notice is not needed if your expedited appeal request is filed verbally. People of all ages can be infected. Obstetrician care provided by an out-of-network obstetrician will be covered for pregnant members inclusive of postpartum care. Q. A. If at any time you need help filing one, call us. Incorrect forms will not be considered and may lead to further delays in processing prior authorization requests. Click below for more information from Absolute Total Care: You are now able to view your health information from a third-party app on a mobile device or PC! We will notify you orally and in writing. Please use WellCare Payor ID 14163. Providers are encouraged to visit the Provider Resources webpagefor manuals, forms, and resources related to claims submission, eligibility, prior authorization, and more. More Information Coronavirus (COVID-19) P.O. Ambetter Timely Filing Limit of : 1) Initial Claims. 3) Coordination of Benefits. Our toll-free fax number is 1-877-297-3112. The onlineProvider Manual represents the most up-to-date information on Absolute Total Cares Medicaid Plan, programs, policies, and procedures. The state has also helped to set the rules for making a grievance. hYnH~}9'I`@>cLq,&DYH"W~&eJx'"luWU]JDBFRJ!*SN(s'6# ^*dg4$SB7K4z:r6')baka+Raf4J=)l, _/jaSpao69&&_Ln=?/{:,'z .1J0|~jv4[eUN{:-gl! K'&hng?y},&X/|OzcJ@0PhDiO})9RA9tG%=|rBhHBz7 Call us to get this form. South Carolina DEPARTMENT OF HEALTH AND HUMAN SERVICES Post Office Box 8206 Columbia, South Carolina 29202-8206 www.scdhhs.gov November 24, 2009 ALL . Professional and Institutional Encounter EDI transactions should be submitted to WellCare of South Carolina Medicaid with Payer ID 59354. Q. Providers can begin requesting prior authorization from Absolute Total Care for dates of service on or after 4/1/2021 from Absolute Total Care on March 15, 2021. Payments mailed to providers are subject to USPS mailing timeframes. Claims will be processed according to timely filing provisions in the providers Absolute Total Care Participating Provider Agreement. To avoid rejections please split the services into two separate claim submissions. To do so by phone, call Member Services at 1-888-588-9842 (TTY1-877-247-6272). Q. Box 100605 Columbia, SC 29260. Members will receive a 90-day transition of care period if the member is receiving ongoing care and treatment. Want to receive your payments faster to improve cash flow? S< Explains rules and state, line of business and CMS-specific regulations regarding 837I EDI transactions. With the completion of this transaction, we have created a premier healthcare enterprise focused on government-sponsored healthcare programs. Date of Occurrence/DOSApril 1, 2021 and after: Processed by Absolute Total Care. The hearing officer does not decide in your favor. Exceptions to the one-year time limit: a) Medicare Cost Sharing Claims . 1071 0 obj <>/Filter/FlateDecode/ID[<87133B316ADA4BDD8B85BA48A489D34F>]/Index[1044 53]/Info 1043 0 R/Length 117/Prev 692690/Root 1045 0 R/Size 1097/Type/XRef/W[1 2 1]>>stream Do I need to do anything additional to provide services on or after 4/1/2021 if I am in network with both WellCare and Absolute Total Care? This person has all beneficiary rights and responsibilities during the appeal process. To earn rewards, members must: Download the Go365 for Humana Healthy Horizons app onto a mobile device from the Apple App Store or Google Play. WellCare Medicare Advantage Claims must be filed within 180 calendar days from the date of service. Awagandakami Effective January 1, 2015 the South Carolina Department of Health and Human Services (SCDHHS) will implement a Claim Reconsideration Policy. For as long as your member has an active WellCare subscriber number, you should continue to submit claims directly to WellCare as you have in the past. APPEALS, GRIEVANCES AND PROVIDER DISPUTES. Claims for services on or after April 1, 2021 should be filed to Absolute Total Care for processing. The rules include what we must do when we get a grievance. An authorized representative is someone you select to act on the behalf of a member to assist them through the appeals process. Example of how to properly split claim that span the cutover date of April 1, 2021: Yes, Absolute Total Care and WellCare will continue to offer Medicare products under their current brands and product names, until further notice. How are WellCare Medicaid member authorizations being handled after April 1, 2021? In this section, we will explain how you can tell us about these concerns/grievances. Please use the From Date Institutional Statement Date. A. endstream endobj 1045 0 obj <>/Metadata 50 0 R/OpenAction 1046 0 R/Outlines 160 0 R/Pages 1042 0 R/StructTreeRoot 166 0 R/Type/Catalog/ViewerPreferences<>>> endobj 1046 0 obj <> endobj 1047 0 obj <>/Font<>/ProcSet[/PDF/Text/ImageC/ImageB/ImageI]/XObject<>>>/Rotate 0/StructParents 0/Tabs/S/TrimBox[0.0 0.0 612.0 792.0]/Type/Page>> endobj 1048 0 obj <>stream South Carolina Department of Health and Human Services Division of Appeals and Hearings P.O. We expect this process to be seamless for our valued members, and there will be no break in their coverage. To do so by phone, call Member Services at 1-888-588-9842 (TTY1-877-247-6272). From time to time, WellCare Health Plans reviews its reimbursement policies to maintain close alignment with industry standards and coding updates released by health care industry sources like the Centers for Medicare and Medicaid Services (CMS), and nationally recognized health and medical societies. Explains how to receive, load and send 834 EDI files for member information. Keep yourself informed about Coronavirus (COVID-19.) Register now at https://www.payspanhealth.comor contact PaySpan at providersupport@payspanhealth.com, or 877-331-7154. Providers do not need to do anything additional to provide services on or after 4/1/2021 if the provider is in network with both WellCare and Absolute Total Care. A. Or it can be made if we take too long to make a care decision. * Password. Absolute Total Care will honor all existing WellCare authorization approvals that include dates of service beyond March 31, 2021. If an authorization is needed, you can log in to the Secure Provider Portalto submit and confirm authorizations. Q. Welcome to WellCare Provider Login Contact Us Join Our Network Medicaid Medicare Tools News and Education AcariaHealth Specialty Pharmacy Pharmacy Forms Request for Drug Coverage Request to Review Drug Coverage Denial . Q. Our fax number is 1-866-201-0657. Q. It is 30 days to 1 year and more and depends on . For general questions about claims submissions, call Provider Claims Services at 1-800-575-0418. Providers are encouraged to sign up to receive EFT payments to avoid any payment delays. Please make sure you ask your members for a copy of their Absolute Total Care and Healthy Connections Choices Medicaid ID cards before each visit. the timely filing limits due to the provider being unaware of a beneficiary's coverage. Absolute Total Care will utilize credentialing cycles from WellCare and Absolute Total Care so that providers will only need to credential once every three years. Claims submission, correspondence, and contact resources will stay the same for the Medicare line of business. All billing requirements must be adher ed to by the provider in order to ensure timely processing of claims. However, there will be no members accessing/assigned to the Medicaid portion of the agreement. We will give you information to help you get the most from your benefits and the services we provide. WellCare claims will be processed according to timely filing provisions in the providers WellCare Participating Provider Agreement. Providers are encouraged to visit the Provider Resources page at absolutetotalcare.com for manuals, forms and resources related to claims submission, eligibility, prior authorization and more. We encourage you to check the Medicaid Pre-Auth Check Toolto ensure that you are accessing the most current Absolute Total Care authorization requirements for dates of service on or after April 1, 2021. WellCare of South Carolinawants to ensure that claims are handled as efficiently as possible. You and the person you choose to represent you must sign the AOR statement. We expect this process to be seamless for our valued members and there will be no break in their coverage. P.O. Member Appeals (Medical, Behavioral Health, and Pharmacy): You will need Adobe Reader to open PDFs on this site. From time to time, Wellcare Health Plans reviews its reimbursement policies to maintain close alignment with industry standards and coding updates released by health care industry sources like the Centers for Medicare and Medicaid Services (CMS), and nationally recognized health and medical societies. WellCare of North Carolina partners with providers to develop and deliver high-quality, cost-effective health care solutions. This manual sets forth the policies and procedures that providers participating in the Wellcare Prime network are required tofollow. P.O. If you request a hearing, the request must: A State Fair Hearing is a legal proceeding. Examples of good cause include, but are not limited to, the following: We will send you a letter within five business days of getting your appeal. Forms. Finding a doctor is quick and easy. Please make sure you ask your members for a copy of their Absolute Total Care and Healthy Connections Choices Medicaid ID cards before each visit. Providers can help facilitate timely claim payment by having an understanding of our processes and requirements. Absolute Total Care will honor those authorizations. Reminder: It is important that providers check eligibility prior to providing services as members can potentially change plans prior to April 1, 2021 if they are in the annual choice period. Box 3050 WellCare Medicaid members migrating to Absolute Total Care will be assigned to their assigned WellCare primary care provider as if the primary care provideris in network with Absolute Total Care. All transitioning Medicaid members will receive a welcome packet and new ID card from Absolute Total Care in March 2021 and will use the Absolute Total Care ID card to get prescriptions and access health care services starting April 1, 2021. Search for primary care providers, hospitals, pharmacies, and more! WellCare offers participating providers EFT and ERA services at no charge through PaySpan Health. DOS prior to April 1, 2021: Processed by WellCare. Providers can begin requesting prior authorization from Absolute Total Care for dates of service on or after April 1, 2021 from Absolute Total Care on March 15, 2021. Providers are encouraged to visit the Provider Resources webpageformanuals, forms, clinical policies, payment policies, provider news and resources related to claims submission, eligibility, prior authorization and more. For example, if a payer has a 90-day timely filing requirement, that means you need to submit the claim within 90 days of the date of service. L]4(f4/pn~YTZSp-5/O*F)e~p:a6o{x8r WellCare Health Plans, Inc. (NYSE: WCG) is now offering a $120 credit per family, per year towards over-the-counter (OTC) items as part of its Medicaid program benefits in South Carolina. Farmington, MO 63640-3821. $8v + Yu @bAD`K@8m.`:DPeV @l For example, if any patient gets services on the 1st of any month then there is a time limit to submit his/her claim to the insurance company for reimbursement. Q. A. We process check runs daily, with the exception of Sundays, National Holidays, and the last day of the month. Outpatient Prior Authorization Form (PDF) Inpatient Prior Authorization Form (PDF) DOSApril 1, 2021 and after: Processed by Absolute Total Care. Timely Filing Limits for all Insurances updated (2023) - Bcbsproviderphonenumber Timely Filing Limits for all Insurances updated (2023) One of the common and popular denials is passed the timely filing limit. First Choice can accept claim submissions via paper or electronically (EDI). Copyright 2023 Wellcare Health Plans, Inc. You can file the grievance yourself. From time to time, Wellcare Health Plans reviews its reimbursement policies to maintain close alignment with industry standards and coding updates released by health care industry sources like the Centers for Medicare and Medicaid Services (CMS), and nationally recognized health and medical societies. The member will be encouraged to establish care with a new in network primary care provider/specialist prior to the end of the transition/continuity of care period to review present treatment plan and coordinate the member's medical care. How do I determine if an institutional inpatient bill type submission overlapping 4/1/2021 should be filed to WellCare or Absolute Total Care? You and the person you choose to represent you must sign the AOR form. Providers interested in joining the Absolute Total Care vision network for routine vision services can contact Envolve Vision at 1-800-531-2818. A. Box 8206 For as long as your member has an active WellCare subscriber number, you should continue to submit claims directly to WellCare as you have in the past. * Username. Members will need to talk to their provider right away if they want to keep seeing him/her. Members will receive a 90-day transition of care period if the member is receiving ongoing care and treatment. Providers do not need to do anything additional to provide services on or after 4/1/2021 if the provider is in network with both WellCare and Absolute Total Care. Professional and Institutional Fee-For-Service/Encounter EDI transactions should be submitted to Absolute Total Care Medicaid with Payer ID 68069 for Emdeon/WebMD/Payerpath or 4272 for Relay Health/McKesson. A. 2023 Medicare and PDP Compare Plans and Enroll Now Notice of Non-Discrimination We comply with applicable Federal civil rights laws and do not discriminate on the basis of race, color, national origin, age, sex, or disability. Download the free version of Adobe Reader. We expect this process to be seamless for our valued members and there will be no break in their coverage. Q. Thanka kaa yoa Tufrbeau ingsnh ngetfu South Caralaita nouMa mpvd. Earliest From Dates prior to April 1, 2021 should be filed to WellCare of South Carolina. If you need assistance with your appeal please call Absolute Total Care at 1-866-433-6041 (TTY: 711) and we will assist you in filing your appeal. Beginning, March 14 March 31, 2021, please send to WellCare, April 1 April 3, 2021, please send to Absolute Total Care, DOS prior to 4/1/2021- Processed by WellCare, DOS 4/1/2021 and after- Processed by Absolute Total Care, Date of Occurrence/DOS prior to 4/1/2021- Processed by WellCare, Date of Occurrence/DOS 4/1/2021 and after- Processed by Absolute Total Care. WellCare of South Carolina will be known as Absolute Total Care as of April 1, 2021. Contact Us Y0020_WCM_100876E Last Updated On: 10/1/2022 Absolute Total Care will continue to offer Marketplace products under the Ambetter brand. Claims for services prior to April 1, 2021 should be filed to WellCare for processing. The member will be encouraged to establish care with a new in network PCP/specialist prior to the end of the transition/continuity of care period to review present treatment plan and coordinate the member's medical care. hb```b``6``e`~ "@1V NB, For current information, visit the Absolute Total Care website. Where should I submit claims for WellCare Medicaid members? We will do this as quickly as possible as but no longer than 72-hours from the decision. You can ask in writing for a State Fair Hearing (hearing, for short). Absolute Total Care will continue to offer Marketplace products under the Ambetter brand. 2023 Medicare and PDP Compare Plans and Enroll Now. Box 31224 WellCare has partnered with Change Healthcare as our preferred EDI Clearinghouse. Medicaid Claims Payment Policies P.O. If Statement Range is March 14, 2021 through April 3, 2021, please send to WellCare. Electronic and Paper Claims Submissions; Institutional Claims/Encounter Guides. P.O. Tampa, FL 33631-3372. Providers interested in joining the Absolute Total Care provider network should submit a request to the Network Development and Contracting Department via email at atc_contracting@centene.com. Wellcare uses cookies. %PDF-1.6 % Pregnant members receiving care from an out of network Obstetrician can continue to see their current Obstetrician until after the baby is born. You can do this at any time during your appeal. All dates of service on or after 4/1/2021 should be filed to Absolute Total Care. However, there will be no members accessing/assigned to the Medicaid portion of the agreement. Earliest From Dates on or after 4/1/2021 should be filed to Absolute Total Care. Learn how you can help keep yourself and others healthy. You, your friend, a relative, legal counsel or other spokesperson who has your written consent may ask for a State Fair Hearing. Professional and Institutional Fee-For-Service EDI transactions should be submitted to WellCare of South Carolina Medicaid with Payer ID 14163. Will Absolute Total Care change its name to WellCare? Stay informed - activate your online account Behavioral Health Crisis Line 844-594-5076 (TTY 711) 24 hours a day, seven days a week Call us if you are experiencing emotional or mental pain or distress. Our call centers, including the nurse advice line, are currently experiencing high volume. Providers will continue to work directly with WellCare to address any claims for dates of service prior to the membership transfer of April 1, 2021. Additionally, WellCare will have a migration section on their provider page at publishing FAQs. You will need Adobe Reader to open PDFs on this site. If an authorization is needed, you can log in to the Secure Provider Portal at absolutetotalcare.com to submit and confirm authorizations. Register now. Members who are dealing with stress or anxiety can call our 24-Hour Behavioral Health Crisis Line at 1-833-207-4240 to speak with a trained professional. A. Explains rules and state, line of business and CMS-specific regulations regarding 837I EDI transactions. Wellcare Health Plans, Inc., complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. WellCare of North Carolina will begin to release medical payments to providers beginning July 6, 2021. Resources Copyright 2023 Wellcare Health Plans, Inc. If Medicare is the primary payer, timely filing is determined from the processing date indicated on the primary carrier's explanation of benefit (EOB) If Medicare is the Secondary Payer (MSP), the initial claim must be submitted to the primary payer within Cigna's timely filing period. We expect this process to be seamless for our valued members, and there will be no break in their coverage. WellCare claims will be processed according to timely filing provisions in the providers WellCare Participating Provider Agreement. Q. Timely Filing Limit: Timely Filing Limit is the time frame set by insurance companies and provider has to submit health care claims to respective insurance company within the set time frame for reimbursement of the claims. Tampa, FL 33631-3372. Wellcare uses cookies. ?-}++lz;.0U(_I]:3O'~3-~%-JM Will my existing WellCare patients be assigned to my Absolute Total Care Panel? If Statement Range is April 2, 2021 through April 10, 2021, please send to Absolute Total Care. All dates of service prior to April 1, 2021 should be filed to WellCare of South Carolina. Copyright 2023 Wellcare Health Plans, Inc. Earliest From Dates on or after April 1, 2021 should be filed to Absolute Total Care. With quality healthcare solutions, Ambetter from Absolute Total Care helps residents of South Carolina live better.