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? Q. 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. Wellcare wants to ensure that claims are handled as efficiently as possible. 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. Date of Occurrence/DOSprior toApril 1, 2021: Processed by WellCare. WellCare of South Carolina will be known as Absolute Total Care as of April 1, 2021. However, there will be no members accessing/assigned to the Medicaid portion of the agreement. DOS prior to April 1, 2021: Processed by WellCare. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. DOSApril 1, 2021 and after: Processed by Absolute Total Care. This person has all beneficiary rights and responsibilities during the appeal process. 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. Professional and Institutional Encounter EDI transactions should be submitted to WellCare of South Carolina Medicaid with Payer ID 59354. Coronavirus Disease 2019 (COVID-19) causes respiratory illness in people and can spread from person to person. You do not appeal within 10 calendar days from when the Plan mails an adverse Notice of Action, or you do not request a hearing within 10 calendar days from when the Plan mails an adverse Notice of Appeals Resolution whichever is later. Please use WellCare Payor ID 14163. Register now at https://www.payspanhealth.comor contact PaySpan at providersupport@payspanhealth.com, or 877-331-7154. To avoid rejections please split the services into two separate claim submissions. Members must have Medicaid to enroll. It was a smart move. Copyright 2023 Wellcare Health Plans, Inc. Members can continue to receive services from their current WellCare provider as long as they remain covered under WellCare. 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. More Information Need help? 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. Want to receive your payments faster to improve cash flow? You, your friend, a relative, legal counsel or other spokesperson who has your written consent may ask for a State Fair Hearing. A. WellCare credentialing cycles will be shared with Absolute Total Care in order to reduce duplicative credentialing in the future. Will WellCare continue to offer current products or Medicare only? PROVIDERS NOTE:Please send Corrected Claims as normal submissions via electronic or paper. To continue providing transition of care services, providers that are not part of the Absolute Total Care network must agree to work with Absolute Total Care and accept Absolute Total Cares payment rates. Overview & Resources WellCare of North Carolina partners with providers to develop and deliver high-quality, cost-effective health care solutions. From Date Institutional Statement Dates prior to 4/1/2021 should be filed to WellCare of South Carolina. Refer to your particular provider type program chapter for clarification. Providers are encouraged to sign up to receive EFT payments to avoid any payment delays. How do I join Absolute Total Cares provider network? Box 600601 Columbia, SC 29260. Symptoms are flu-like, including: Fever Coughing 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. First Choice can accept claim submissions via paper or electronically (EDI). Or you can have someone file it for you. Pharmacy services prior to April 1, 2021 must be requested from WellCare of South Carolina. 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. DOS prior toApril 1, 2021: Processed by WellCare. Send your written appeal to: We must have your written consent before someone can file an appeal for you. Division of Appeals and Hearings BlueCross BlueShield of South Carolina Piedmont Service Center P.O. 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. Members will receive a 90-day transition of care period if the member is receiving ongoing care and treatment. 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. As of April 1, 2021, WellCare will no longer be a separate plan option offered by South Carolina Healthy Connections Choices. Please use the Earliest From Date. A. 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. How do I bill a professional submission with services spanning before and after 04/01/2021? How do I determine if an institutional inpatient bill type submission overlapping 4/1/2021 should be filed to WellCare or Absolute Total Care? Farmington, MO 63640-3821. 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. We are committed to improving the quality of life of our millions of members, who often include some of our nations most vulnerable populations. When you receive your notification of WellCares grievance resolution, and you are dissatisfied with the resolution regarding adverse decisions that affect your ability to receive benefits, access to care, access to services or payment for care of services, you may request a second level review with WellCare. Example of how to properly split claim that span the cutover date of April 1, 2021: Q. 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. 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. For standard requests, if you call in your appeal, you must follow up with a written, signed one, within thirty calendar days. WellCare understands that having access to the right tools can help you and your staff streamline day-to-day administrative tasks. Pregnant members receiving care from an out-of-network Obstetrician can continue to see their current obstetrician until after the baby is born. The Medicare portion of the agreement will continue to function in its entirety as applicable. We are proud to announce that WellCare is now part of the Centene Family. 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. 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. You can ask in writing for a State Fair Hearing (hearing, for short). $8v + Yu @bAD`K@8m.`:DPeV @l You and the person you choose to represent you must sign the AOR form. All billing requirements must be adher ed to by the provider in order to ensure timely processing of claims. Please note - a representative may file for a member who: If the members request for appeal is submitted after 60 calendar days from the date on the NABD, then good cause must be shown in order for WellCare to accept the late request. WellCare of South Carolina will be known as Absolute Total Care as of April 1, 2021. They must inform their vendor of AmeriHealth Caritas . Payments mailed to providers are subject to USPS mailing timeframes. If an authorization is needed, you can log in to the Secure Provider Portal at absolutetotalcare.com to submit and confirm authorizations. From Date Institutional Statement Dates on or after April 1, 2021 should be filed to Absolute Total Care. You can file your appeal by calling or writing to us. The onlineProvider Manual represents the most up-to-date information on Wellcare Prime by Absolute Total Care (Medicare-Medicaid Plan), programs, policies, and procedures. ?-}++lz;.0U(_I]:3O'~3-~%-JM Attn: Grievance Department Earliest From Dates on or after 4/1/2021 should be filed to Absolute Total Care. Instructions on how to submit a corrected or voided claim. Box 6000 Greenville, SC 29606. As of April 1, 2021 Absolute Total Care, a Centene company, is now the health plan for South Carolina Medicaid members. Always verify timely filing requirements with the third party payor. That's why we provide tools and resources to help. Will Absolute Total Care change its name to WellCare? 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. As of April 1, 2021, all WellCare of South Carolina Medicaid members will transfer to Absolute Total Care. You will need Adobe Reader to open PDFs on this site. #~0 I
You or your provider must call or fax us to ask for a fast appeal. For dates of service on or after April 1, 2021: Absolute Total Care Wellcare uses cookies. P.O. 1044 0 obj
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A grievance is when you tell us about a concern you have with our plan. It can also be about a provider and/or a service. WellCare offers participating providers EFT and ERA services at no charge through PaySpan Health. Professional and Institutional Encounter EDI transactions should be submitted to WellCare of South Carolina Medicaid with Payer ID 59354. For dates of service prior to April 1, 2021: All paper claim submissions can be mailed to: WellCare Health Plans You may file your second level grievance review within 30 days of receiving your grievance decision letter. 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 To avoid rejections please split the services into two separate claim submissions. 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. WellCare and Absolute Total Care Medicare plans will continue to operate under current brands, product names and provider contracts, until further notice. and Human Services 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. A. A. We will review it and send you a decision letter within 30 calendar days from receiving your appeal. A. Absolute Total Care will honor those authorizations. 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. WellCare of North Carolina will begin to release medical payments to providers beginning July 6, 2021. More Information Coronavirus (COVID-19) Ambetter Timely Filing Limit of : 1) Initial Claims. It will let you know we received your appeal. We will call you with our decision if we decide you need a fast appeal. To do so by phone, call Member Services at 1-888-588-9842 (TTY1-877-247-6272). Reconsideration or Claim Disputes/Appeals: Know the facts about Coronavirus (COVID-19) Our call centers, including the nurse advice line, are currently experiencing high volume. It will tell you we received your grievance. Go365 for Humana Healthy Horizons Members can register for the new Go365 for Humana Healthy Horizons wellness program and earn rewards for participating in healthy activities. WellCare offers participating providers EFT and ERA services at no charge through PaySpan Health. We have licensed clinicians available to speak with you and to connect you to the support you need to feel better. Search for primary care providers, hospitals, pharmacies, and more! We will give you information to help you get the most from your benefits and the services we provide. We want you to let us know right away if you have any questions, grievances or problems with your covered services or the care you receive. Instructions on how to submit a corrected or voided claim. How do I determine if a professional or an outpatient bill type institutional submission should be filed to WellCare or Absolute Total Care? To have someone represent you, you must complete an Appointment of Representative (AOR) form. The second level review will follow the same process and procedure outlined for the initial review. 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. This gives members time to establish with a new provider in the network and ensure that they have continuity of care. Claims for services prior to April 1, 2021 should be filed to WellCare for processing. South Carolina Department of Health and Human Services Division of Appeals and Hearings P.O. Shop or Enroll in a Plan Frequently Asked Questions Find a Doctor Download Digital ID Card Welcome Allwell Members! WellCare is the health care plan that puts you in control. (This includes your PCP or another provider.) As of April 1, 2021, all WellCare of South Carolina Medicaid members will transfer to Absolute Total Care. The Medicare portion of the agreement will continue to function in its entirety as applicable. 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. You can make three types of grievances. With quality healthcare solutions, Ambetter from Absolute Total Care helps residents of South Carolina live better. Download the free version of Adobe Reader. 0
Wellcare uses cookies. Utilize interactive health and wellness tools to help you manage conditions, improve your health and save money. you have another option. P.O. Effective January 1, 2015 the South Carolina Department of Health and Human Services (SCDHHS) will implement a Claim Reconsideration Policy. The participating provider agreement with WellCare will remain in-place after 4/1/2021. %PDF-1.6
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Check out the Interoperability Page to learn more. WellCare claims will be processed according to timely filing provisions in the providers WellCare Participating Provider Agreement. In South Carolina, WellCare and Absolute Total Care are joining to better serve you. endstream
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Please see list of services that will require authorization during this time. Claim Filing Manual - First Choice by Select Health of South Carolina Members will need to talk to their provider right away if they want to keep seeing him/her. Claims will be processed according to timely filing provisions in the providers Absolute Total Care Participating Provider Agreement. If Statement Range is April 2, 2021 through April 10, 2021, please send to Absolute Total Care. Box 3050 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. 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. Q. At the hearing, well explain why we made our decision. Additionally, WellCare will have a migration section on their provider webpage publishing FAQs. Earliest From Dates prior to 4/1/2021 should be filed to WellCare of South Carolina. We will continue covering your medical services during your appeal request and State Fair Hearing if all of the following are meet. The annual flu vaccine helps prevent the flu. To do this: 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. 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. Visit https://msp.scdhhs.gov/appeals/ to: Copyright 2023 Wellcare Health Plans, Inc. https://msp.scdhhs.gov/appeals/site-page/file-appeal, If we deny or limit a service you or your doctor asks us to approve, If we reduce, suspend or stop services youve been getting that we already approved, If we do not pay for the health care services you get, If we fail to give services in the required timeframe, If we fail to give you a decision in the required timeframe on an appeal you already filed, If we dont agree to let you see a doctor who is not in our network and you live in a rural area or in an area with limited doctors, If you dont agree with a decision we made regarding your medicine, We denied your request to dispute a financial liability, The member did not personally receive the notice of action or received the notice late, The member was seriously ill, which prevented a timely appeal, There was a death or serious illness in the members immediate family, An accident caused important records to be destroyed, Documentation was difficult to locate within the time limits; and/or the member had incorrect or incomplete information concerning the appeals process, Change the appeal to the timeframe for a standard decision (30 calendar days), Follow up with a written letter within 2 calendar days, Tell you over the phone and in writing that you may file a grievance about the denial of the fast appeal request, Be in writing and specify the reason for the request, Include your name, address and phone number, Indicate the date of service or the type of service denied, Your authorized representative (if youve chosen one), A hearing officer from Medicaid and Long-Term Care (MLTC), You or your authorized representative with your written consent must file your appeal with us and ask to continue your benefits within 10 calendar days after we mail the Notice of Adverse benefit determination; or, Within 10 calendar days of the intended effective date of the plans proposed action, whichever is later, The appeal or hearing must address the reduction, suspension or stopping of a previously authorized service, The services were ordered by an authorized provider, The period covered by the original authorization cannot have ended. Member Sign-In. The participating provider agreement with WellCare will remain in-place after 4/1/2021. 837 Institutional Encounter 5010v Guide 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. With the completion of this transaction, we have created a premier healthcare enterprise focused on government-sponsored healthcare programs. You will have a limited time to submit additional information for a fast appeal. 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. Download the free version of Adobe Reader. 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 onlineProvider Manual represents the most up-to-date information on Absolute Total Cares Medicaid Plan, programs, policies, and procedures. Wellcare uses cookies. 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. Providers are encouraged to visit the Provider Resources webpagefor manuals, forms, and resources related to claims submission, eligibility, prior authorization, and more. Q. 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. 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. A. Q. 2) Reconsideration or Claim disputes/Appeals. 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. We expect this process to be seamless for our valued members, and there will be no break in their coverage. Columbia, SC 29202-8206. As of April 1, 2021, WellCare will no longer be a separate plan option offered by South Carolina Healthy Connections Choices. Absolute Total Care will continue to offer Marketplace products under the Ambetter brand. As of April 1, 2021, all WellCare of South Carolina Medicaid members will become Absolute Total Care members. Federal Employee Program (FEP) Federal Employee Program P.O. Box 8206 Columbia, SC 29202-8206 Or call 1-800-763-9087. Q. Q. If you need claim filing assistance, please contact your provider advocate. Members will need to talk to their provider right away if they want to keep seeing him/her. Q. 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. Can I continue to see my current WellCare members? 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. Providers interested in joining the Absolute Total Care vision network for routine vision services can contact Envolve Vision at 1-800-531-2818. A. Timely filing is when you file a claim within a payer-determined time limit. 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 . Beginning. Providers will follow Absolute Total Care Medicaid policies and procedures for all services, inclusive of medical, behavioral, and pharmaceutical benefits, provided to WellCare Medicaid members transitioning to Absolute Total Care for dates of service on or after April 1, 2021. Explains how to receive, load and send 834 EDI files for member information. A. 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. Additionally, WellCare will have a migration section on their provider page at