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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 interested in joining the Absolute Total Care vision network for routine vision services can contact Envolve Vision at 1-800-531-2818. The materials located on our website are for dates of service prior to April 1, 2021. From Date Institutional Statement Dates prior to April 1, 2021 should be filed to WellCare of South Carolina. We would like to help your billing department get your EDI (claims and real time) transactions processed as efficiently as possible. Absolute Total Care will continue to offer Marketplace products under the Ambetter brand. We expect this process to be seamless for our valued members and there will be no break in their coverage. Explains how to receive, load and send 834 EDI files for member information. We're here for you. A. WellCare credentialing cycles will be shared with Absolute Total Care in order to reduce duplicative credentialing in the future. You can do this at any time during your appeal. The hearing officer does not decide in your favor. These SNP plans provide benefits beyond Original Medicare, and may include transportation to medical appointments and vision exams. Please use the Earliest From Date. Claim Filing Manual - First Choice by Select Health of South Carolina You can also have a video visit with a doctor using your phone or computer. the timely filing limits due to the provider being unaware of a beneficiary's coverage. Providers can help facilitate timely claim payment by having an understanding of our processes and requirements. Wellcare uses cookies. The current transaction means that WellCare of South Carolina Medicaid members are transitioning to Absolute Total Care and will become Absolute Total Care members, effective April 1, 2021. How will credentialing/recredentialing be handled by Absolute Total Care if a provider was recently credentialed/recredentialed by WellCare? Contact Wellcare Prime Provider Service at 1-855-735-4398 if you have questions. To do so by phone, call Member Services at 1-888-588-9842 (TTY1-877-247-6272). A. 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! Absolute Total Care will utilize credentialing cycles from WellCare and Absolute Total Care so that providers will only need to recredential once every three years. Members will need to talk to their provider right away if they want to keep seeing him/her. You or your authorized representative can review the information we used to make our decision. Absolute Total Care will honor those authorizations. 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. Providers are encouraged to sign up to receive EFT payments to avoid any payment delays. Because those authorizations will automatically transfer to Absolute Total Care, it is not necessary to request the authorization again when the member becomes eligible with Absolute Total Care. The onlineProvider Manual represents the most up-to-date information on Wellcare Prime by Absolute Total Care (Medicare-Medicaid Plan), programs, policies, and procedures. You may file your second level grievance review within 30 days of receiving your grievance decision letter. Providers can begin requesting prior authorization for pharmacy services from Absolute Total Care for dates of service on or after 4/1/2021 from Absolute Total Care on April 1, 2021. UHC Community TFL - Timely filing Limit: 120 Days: Unitedhealthcare TFL - Timely filing Limit: Participating Providers: 90 days Non Participating Providers: 180 Days If its secondary payer: 90 days from date of Primary Explanation of Benefits Unitedhealthcare timely filing limit for appeals: 12 months from original claim determination You will need Adobe Reader to open PDFs on this site. To do this: Be sure to ask us to continue your benefits within the 10 calendar day time frame. The rules include what we must do when we get a grievance. We encourage you to check the Medicaid Pre-Auth Check Tool in the For Providers section on the Absolute Total Care website at absolutetotalcare.com to ensure that you are accessing the most current Absolute Total Care authorization requirements for dates of service on or after 4/1/2021. An authorized representative is someone you select to act on the behalf of a member to assist them through the appeals process. For dates of service on or after April 1, 2021: Absolute Total Care It will tell you we received your grievance. For requests involving dates of service on April 1, 2021 and beyond, Absolute Total Care will follow Medicaid contract requirements allowing a 90-day transition of care period. Providers do not need to do anything additional to provide services on or after April 1, 2021 if the provider is in network with both WellCare and Absolute Total Care. Wellcare wants to ensure that claims are handled as efficiently as possible. 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. You must ask within 30 calendar days of getting our decision. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. Members must have Medicaid to enroll. Reimbursement Policies Pregnant members receiving care from an out of network Obstetrician can continue to see their current Obstetrician until after the baby is born. As of April 1, 2021, all WellCare of South Carolina Medicaid members will transfer to Absolute Total Care. We are glad you joined our family! To avoid rejections please split the services into two separate claim submissions. If you think you might have been exposed, contact a doctor immediately. Professional and Institutional Fee-For-Service EDI transactions should be submitted to WellCare of South Carolina Medicaid with Payer ID 14163. These grievances may be about: The state of South Carolina allows members to file a grievance at anytime from the event that caused the dissatisfaction. 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. What is the Rx BIN and Group Number for WellCare members transitioning to Absolute Total Care on April 1, 2021? Copyright 2023 Wellcare Health Plans, Inc. WellCare and Absolute Total Care Medicare plans will continue to operate under current brands, product names and provider contracts, until further notice. We will review it and send you a decision letter within 30 calendar days from receiving your appeal. What will happen to my Participating Provider Agreement with WellCare after 4/1/2021? South Carolina DEPARTMENT OF HEALTH AND HUMAN SERVICES Post Office Box 8206 Columbia, South Carolina 29202-8206 www.scdhhs.gov November 24, 2009 ALL . 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. An appeal may be filed within 60 calendar days from the date on the Adverse Benefit Determination Notice. Explains rules and state, line of business and CMS-specific regulations regarding 837P EDI transactions. %%EOF Written notice is not needed if your expedited appeal request is filed verbally. A grievance is when you tell us about a concern you have with our plan. Will Absolute Total Care change its name to WellCare? We expect this process to be seamless for our valued members, and there will be no break in their coverage. Pharmacy services prior to 4/1/2021 must be requested from WellCare South Carolina. Absolute Total Care will continue to offer Marketplace products under the Ambetter brand. Claims will be processed according to timely filing provisions in the providers Absolute Total Care Participating Provider Agreement. 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. You can file a grievance by calling or writing to us. WellCare is the health care plan that puts you in control. Prior authorizations issued by WellCare for dates of service on or after 4/1/2021 will transfer with the members eligibility to Absolute Total Care. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. Forms. Explains how to receive, load and send 834 EDI files for member information. Date of Occurrence/DOSApril 1, 2021 and after: Processed by Absolute Total Care. Q. The Medicare portion of the agreement will continue to function in its entirety as applicable. We will call you with our decision if we decide you need a fast appeal. To have someone represent you, you must complete an Appointment of Representative (AOR) form. Claims Submission, Correspondence and Contact Resources will stay the same for the Medicare line of business. Timely filing limits vary. Farmington, MO 63640-3821. The annual flu vaccine helps prevent the flu. If you ask for a fast appeal and we decide that one is not needed, we will: You or your authorized representative can give us more information if you think itll help your appeal (regular or fast). 2) Reconsideration or Claim disputes/Appeals. A. You must file your appeal within 60 calendar days from the date on the NABD. P.O. DOS prior toApril 1, 2021: Processed by WellCare. It can also be about a provider and/or a service. As of April 1, 2021, all WellCare of South Carolina Medicaid members will become Absolute Total Care members. We cannot disenroll you from our plan or treat you differently. Q. Living Well Quality of Care Medicaid Managed Care Medicaid and CHIP Quality Resource Library Improvement Initiatives Performance Measurement Releases & Announcements Enrollment Strategies Continuous Eligibility Express Lane Eligibility Lawfully Residing Immigrant Children & Pregnant Women Presumptive Eligibility Home & Community Based Services PROVIDER REMINDER: It is important that providers check eligibility prior to providing services as members can potentially change plans prior to 4/1/2021 if they are in the annual choice period. Utilize interactive health and wellness tools to help you manage conditions, improve your health and save money. Your second-level review will be performed by person(s) not involved in the first review. For the latest COVID-19 news, visit the CDC. You may do this in writing or in person. 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. Q. We will notify you orally and in writing. pst/!+ Y^Ynwb7tw,eI^ Synagis (RSV) - Medical Benefit or Retail Pharmacy, 17P or Makena - Medical Benefit or Retail Pharmacy, Special Supplemental Benefits for Chronically Ill (SSBCI), Screening, Brief Intervention, and Referral to Treatment (SBIRT), Patient Centered Medical Home Model (PCMH), Healthcare Effectiveness Data and Information Set (HEDIS), Consumer Assessment of Healthcare Providers and Systems (CAHPS), National Committee for Quality Assurance (NCQA), Hurricane Florence: What You Need to Know, Absolute Total Care Payment Policy and Edit Updates Effective 5/1/21, Notice About a New Payment Integrity Audit Program, Absolute Total Care Updated Guidance for Medicaid BabyNet Therapy Providers, Wellcare By Allwell Changing Peer-to-Peer Review Request and Elective Inpatient Prior Authorization Requirements for Medicare Advantage Plans, NEW Attestation Process for Special Supplemental Benefits for Chronically Ill (SSBCI), Medicare Prior Authorization Change Summary - Effective 1/1/2023. We are simplifying Medicare so you can choose and use an affordable local plan that will help you achieve your best possible health. Authorizations already processed by WellCare for any services on or after April 1, 2021, will be moved to Absolute Total Care and there is no need for the provider or member to request these services again. In South Carolina, WellCare and Absolute Total Care are joining to better serve you. With the completion of this transaction, we have created a premier healthcare enterprise focused on government-sponsored healthcare programs. Member Sign-In. These materials are for informational purposes only. All dates of service on or after 4/1/2021 should be filed to Absolute Total Care. Columbia, SC 29202-8206. We expect this process to be seamless for our valued members and there will be no break in their coverage. Where should I submit claims for WellCare Medicaid members that transition to Absolute Total Care? A. Ambetter Timely Filing Limit of : 1) Initial Claims. A. Register now at https://www.payspanhealth.comor contact PaySpan at providersupport@payspanhealth.com, or 877-331-7154. 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. Download the free version of Adobe Reader. Transition/continuity of care is an extended period of time members are given when they join or transfer to another plan in order to receive services from out-of-network providers and/or pharmacies, until that specified period ends. S< 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. Please Explore the Site and Get To Know Us. Our health insurance programs are committed to transforming the health of the community one individual at a time. Can I continue to see my current WellCare members? Please use the From Date Institutional Statement Date. Explains rules and state, line of business and CMS-specific regulations regarding 837I EDI transactions. We will do this as quickly as possible as but no longer than 72-hours from the decision. Copyright 2023 Wellcare Health Plans, Inc. Or you can have someone file it for you. Hearings are used when you were denied a service or only part of the service was approved. 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 If you are unable to view PDFs, please download Adobe Reader. Q. This must be done within 120 days from the date of Notice of Appeal Resolution you received from us. 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. It was a smart move. and Human Services Wellcare uses cookies. Prior authorizations issued by WellCare for dates of service on or after 4/1/2021 will transfer with the members eligibility to Absolute Total Care. For current information, visit the Absolute Total Care website. A. Because those authorizations will automatically transfer to Absolute Total Care, it is not necessary to request the authorization again when the member becomes eligible with Absolute Total Care. 2023 Medicare and PDP Compare Plans and Enroll Now. How do I determine if a professional or an outpatient bill type institutional submission should be filed to WellCare or Absolute Total Care? Get an annual flu shot today. Providers interested in joining the Absolute Total Care Provider Network should submit a request to Network Development and Contracting via email at atc_contracting@centene.com. Please use WellCare Payor ID 14163. 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. WellCare of South Carolinawants to ensure that claims are handled as efficiently as possible. Additionally, WellCare will have a migration section on their provider webpage publishing FAQs. 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 healthcare services starting April 1, 2021. Those who attend the hearing include: You can also request to have your hearing over the phone. Q: What is Absolute Total Cares Transition/Continuity of Care Policy? You can file the grievance yourself. 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. WellCare Medicaid members migrating to Absolute Total Care will be assigned to their assigned WellCare Primary Care Physician (PCP) as if the PCP is in network with Absolute Total Care. 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. Welcome to Wellcare By Allwell, a Medicare Advantage plan. You can ask for a State Fair Hearing after we make our appeal decision. APPEALS, GRIEVANCES AND PROVIDER DISPUTES. Check out the Interoperability Page to learn more. For dates of service on or after 4/1/2021: 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. Forgot Your Password? How do I bill a professional submission with services spanning before and after 04/01/2021? At WellCare, we value everything you do to deliver quality care to our members your patients and ensure they have a positive health care experience. A. Always verify timely filing requirements with the third party payor. Prior authorizations issued by WellCare for dates of service on or after April 1, 2021 will transfer with the members eligibility to Absolute Total Care. 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. To avoid rejections please split the services into two separate claim submissions. Claims for services on or after April 1, 2021 should be filed to Absolute Total Care for processing. We may apply a 14 day extension to your grievance resolution. This manual sets forth the policies and procedures that providers participating in the Wellcare Prime network are required tofollow. 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 . Tampa, FL 33631-3384. Box 600601 Columbia, SC 29260. The annual flu vaccine helps prevent the flu.Protect yourself and those around you. Members will need to talk to their provider right away if they want to keep seeing him/her. We are proud to announce that WellCare is now part of the Centene Family. Example of how to properly split claim that span the cutover date of April 1, 2021: Q. At the hearing, well explain why we made our decision. Copyright 2023 Wellcare Health Plans, Inc. Clinical Laboratory Improvement Amendments (CLIA). 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. We welcome Brokers who share our commitment to compliance and member satisfaction. Copyright 2023 Wellcare Health Plans, Inc. For general questions about claims submissions, call Provider Claims Services at 1-800-575-0418. Yes, Absolute Total Care and WellCare will continue to offer Medicare products under their current brands and product names, until further notice. A. Transition/Continuity of Care is an extended period of time members are given when they join or transfer to another plan in order to receive services from out-of-network providers and/or pharmacies, until that specified period ends. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. 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. 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, Providers can begin requesting prior authorization for pharmacy services from Absolute Total Care for dates of service on or after 4/1/2021 from Absolute Total Care on. WellCare of North Carolina Medicaid providers are not required to obtain an authorization for professional services for the 90-day post-go live period from July 1, 2021 through September 28, 2021. WellCare Medicare members are not affected by this change. You can make three types of grievances. WellCare offers participating providers EFT and ERA services at no charge through PaySpan Health. As of April 1, 2021, all WellCare of South Carolina Medicaid members will become Absolute Total Care members. 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. Exceptions to the one-year time limit: a) Medicare Cost Sharing Claims . There is a lot of insurance that follows different time frames for claim submission. All Paper Claim Submissions can be mailed to: WellCare Health Plans Contact Wellcare Prime Provider Service at1-855-735-4398if youhave questions. This person has all beneficiary rights and responsibilities during the appeal process. WellCare of South Carolina will be known as Absolute Total Care as of April 1, 2021. You or your authorized representative will tell the hearing officer why you think we made the wrong decision. DOS prior to April 1, 2021: Processed by WellCare. If you dont agree with our appeal decision - and you've completed the appeal steps with our health plan - or, if our appeal decision was not made within the required timeframe (30-calendar days for standard appeals or 72 hours for fast appeals), you may request a State Fair Hearing. We try to make filing claims with us as easy as possible. A. If you file a grievance or an appeal, we must be fair. You can ask in writing for a State Fair Hearing (hearing, for short). For the death or injury of a member of the South Carolina National Guard, as provided for in Section 42-7-67, the time for filing a claim is two years after the accident or one year after the federal claim is finalized, whichever is later. If your services are continued during an appeal or a hearing, you can keep getting them until: If the hearing is decided in your favor, well approve and pay for the care that is needed. Explains how to receive, load and send 834 EDI files for member information. With the completion of this transaction, we have created a premier healthcare enterprise focused on government-sponsored healthcare programs. P.O. Q. Q. WellCare claims will be processed according to timely filing provisions in the providers WellCare Participating Provider Agreement. You can get many of your Coronavirus-related questions answered here. April 1-April 3, 2021, please send to Absolute Total Care. \{-w{,xI202100$0*bZf ,X AayhP3pYla" e 3G& `eoT#@ *;d Pregnant members receiving care from an out-of-network Obstetrician can continue to see their current obstetrician until after the baby is born. In this section, we will explain how you can tell us about these concerns/grievances. They must inform their vendor of AmeriHealth Caritas . Within five business days of getting your grievance, we will mail you a letter. Absolute Total Care will honor those authorizations. On June 19, 2018, the Family and Social Services Administration's ("FSSA") Indiana Health Coverage Programs ("IHCP") released provider bulletin BT201829 regarding revising the timely filing limit for Medicaid fee-for-service claims. P.O. 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. A. WellCare Medicaid members migrating to Absolute Total Care will be assigned to their assigned WellCare Primary Care Physician (PCP) as if the PCP is in network with Absolute Total Care. You now have access to a secure, quick way to electronically settle claims. How are WellCare Medicaid member authorizations being handled after April 1, 2021? The second level review will follow the same process and procedure outlined for the initial review. Copyright 2023 WellCare Health Plans, Inc. WellCare Non-Emergency Medical Transportation (NEMT) Update, Provider Self-Service Quick Reference Guide (PDF), Provider Masters Level Proposed Rates (PDF), Member Advisory Committee (MAC) Member Flyer (PDF), Member Advisory Committee (MAC) - LTSS Member Flyer (PDF), Managed Care PHP Member PCP Change Request Form (PDF), Provider Referral Form: LTSS Request for PCS Assessment (PDF). Ambetter from Absolute Total Care - South Carolina. WellCare of South Carolina will be known as Absolute Total Care as of April 1, 2021. 1096 0 obj <>stream Keep yourself informed about Coronavirus (COVID-19.) We expect this process to be seamless for our valued members, and there will be no break in their coverage. We will give you information to help you get the most from your benefits and the services we provide. Please contact our Provider Services Call Center at 1-888-898-7969. However, there will be no members accessing/assigned to the Medicaid portion of the agreement. Members can continue to receive services from their current WellCare provider as long as they remain covered under WellCare. If you need claim filing assistance, please contact your provider advocate. This gives members time to establish with a new provider in the network and ensure that they have continuity of care. All dates of service on or after April 1, 2021 should be filed to Absolute Total Care. Continuation of Benefits During the Appeals Process We will continue covering your medical services during your appeal request and State Fair Hearing if all of the following are meet. If at any time you need help filing one, call us. Q. Explains rules and state, line of business and CMS-specific regulations regarding 837I EDI transactions. Claim Filing AmeriHealth Caritas North Carolina, hereafter referred to as the Plan (where appropriate), is required by the North Carolina and federal regulations to capture specific data regarding services rendered to its members. Professional and Institutional Fee-For-Service EDI transactions should be submitted to WellCare of South Carolina Medicaid with Payer ID 14163. All transitioning Medicaid members will receive a welcome packet and new member ID card from Absolute Total Care in March 2021 and will use the Absolute Total Care ID card to get prescriptions and access healthcare services starting April 1, 2021. 837 Institutional Encounter 5010v Guide Claims submission, correspondence, and contact resources will stay the same for the Medicare line of business. The state has also helped to set the rules for making a grievance. However, there will be no members accessing/assigned to the Medicaid portion of the agreement. All dates of service prior to 4/1/2021 should be filed to WellCare of South Carolina. 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.