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. Q. 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. The hearing officer will decide whether our decision was right or wrong. Providers can begin requesting prior authorization for pharmacy services from Absolute Total Care for dates of service on or after April 1, 2021 from Absolute Total Care on April 1, 2021. 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. L]4(f4/pn~YTZSp-5/O*F)e~p:a6o{x8r We want to ensure that claims are handled as efficiently as possible. 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. Members can continue to receive services from their current WellCare provider as long as they remain covered under WellCare. WellCare Health Plans, Inc. (NYSE: WCG) is now offering a $120 credit per family, per year towards over-the-counter (OTC) items as part of its Medicaid program benefits in South Carolina. Explains how to receive, load and send 834 EDI files for member information. WellCare of South Carolina will be known as Absolute Total Care as of April 1, 2021. These materials are for informational purposes only. On June 19, 2018, the Family and Social Services Administration's ("FSSA") Indiana Health Coverage Programs ("IHCP") released provider bulletin BT201829 regarding revising the timely filing limit for Medicaid fee-for-service claims. The Medicare portion of the agreement will continue to function in its entirety as applicable. WellCare understands that having access to the right tools can help you and your staff streamline day-to-day administrative tasks. The provider needs to contact Absolute Total Care to arrange continuing care. From Date Institutional Statement Dates prior to 4/1/2021 should be filed to WellCare of South Carolina. When can providers begin requesting prior authorization from Absolute Total Care for WellCare Medicaid members for dates of service on or after April 1, 2021? A. The Claim Reconsideration process is an informal claim review, and is not a substitute for an appeal of a final agency decision. Box 100605 Columbia, SC 29260. hbbd``b`$= $ A. 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. Section 1: General Information. You can ask for a State Fair Hearing after we make our appeal decision. A. 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). Q. 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! Member Appeals (Medical, Behavioral Health, and Pharmacy): Copyright 2023 Wellcare Health Plans, Inc. As of April 1, 2021, all WellCare of South Carolina Medicaid members will become Absolute Total Care members. Or it can be made if we take too long to make a care decision. To continue care with their current provider after the 90-day Transition of Care, the provider must agree to work with Absolute Total Care on the member's care and accept Absolute Total Care's payment rates. We will call you with our decision if we decide you need a fast appeal. This manual sets forth the policies and procedures that providers participating in the Absolute Total Carenetwork are required tofollow. Our fax number is 1-866-201-0657. Members will need to talk to their provider right away if they want to keep seeing him/her. From Date Institutional Statement Dates on or after 4/1/2021 should be filed to Absolute Total Care. Absolute Total Care will continue to offer Marketplace products under the Ambetter brand. Providers are encouraged to visit the Provider Resources webpagefor manuals, forms, and resources related to claims submission, eligibility, prior authorization, and more. To do so by phone, call Member Services at 1-888-588-9842 (TTY1-877-247-6272). 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. Learn how you can help keep yourself and others healthy. Know the facts about Coronavirus (COVID-19) Our call centers, including the nurse advice line, are currently experiencing high volume. 2) Reconsideration or Claim disputes/Appeals. Members can continue to receive services from their current WellCare provider as long as they remain covered under WellCare. Q. Medicaid Claims Payment Policies Pregnant members receiving care from an out of network Obstetrician can continue to see their current Obstetrician until after the baby is born. Box 31224 Payments mailed to providers are subject to USPS mailing timeframes. To write us, send mail to: You can fax it too. We expect this process to be seamless for our valued members, and there will be no break in their coverage. Ambetter Timely Filing Limit of : 1) Initial Claims. Providers can help facilitate timely claim payment by having an understanding of our processes and requirements. It will let you know we received your appeal. Your second-level review will be performed by person(s) not involved in the first review. However, as of April 1, 2021, all WellCare of South Carolina Medicaid members will become Absolute Total Care members. Register now. 1044 0 obj <> endobj These SNP plans provide benefits beyond Original Medicare, and may include transportation to medical appointments and vision exams. Wellcare uses cookies. Utilize interactive health and wellness tools to help you manage conditions, improve your health and save money. 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. You must file your appeal within 60 calendar days from the date on the NABD. As of April 1, 2021, WellCare will no longer be a separate plan option offered by South Carolina Healthy Connections Choices. All dates of service on or after 4/1/2021 should be filed 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. Claims will be processed according to timely filing provisions in the providers Absolute Total Care Participating Provider Agreement. All dates of service prior to 4/1/2021 should be filed to WellCare of South Carolina. You will get a letter from us when any of these actions occur. We expect this process to be seamless for our valued members, and there will be no break in their coverage. 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. Finding a doctor is quick and easy. 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. A. Claims for services on or after April 1, 2021 should be filed to Absolute Total Care for processing. Send your written appeal to: We must have your written consent before someone can file an appeal for you. Learn how you can help keep yourself and others healthy. Where should I submit claims for WellCare Medicaid members? From Date Institutional Statement Dates prior to April 1, 2021 should be filed to WellCare of South Carolina. P.O. Welcome to Wellcare By Allwell, a Medicare Advantage plan. Refer to your particular provider type program chapter for clarification. 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. What is the Rx BIN and Group Number for WellCare members transitioning to Absolute Total Care on April 1, 2021? With the completion of this transaction, we have created a premier healthcare enterprise focused on government-sponsored healthcare programs. 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. You, your friend, a relative, legal counsel or other spokesperson who has your written consent may ask for a State Fair Hearing. 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. Will WellCare continue to offer current products or Medicare only? We process check runs daily, with the exception of Sundays, National Holidays, and the last day of the month. Resources It will tell you we received your grievance. April 1-April 3, 2021, please send to Absolute Total Care. Get an annual flu shot today. 1,flQ*!WLOmsmz\D;I5BI,yA#z!vYQi5'fedREF40 b666q1(UtUJJ.i` (T/@E 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. As of April 1, 2021, all WellCare of South Carolina Medicaid members will become Absolute Total Care members. Providers are encouraged to sign up to receive EFT payments to avoid any payment delays. Contact Absolute Total Care Provider Service at1-866-433-6041if youhave questions. Wellcare uses cookies. If an authorization is needed, you can log in to the Secure Provider Portal at absolutetotalcare.com to submit and confirm authorizations. Contact Us Y0020_WCM_100876E Last Updated On: 10/1/2022 Exceptions to the one-year time limit: a) Medicare Cost Sharing Claims . 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. 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. R 1/70.3/Determining End Date of Timely Filing Period -- Receipt Date R 1/70.4/Determination of Untimely Filing and Resulting Actions R 1/70.5/Application to Special Claim Types R 1/70.6/Filing Claim Where General Time Limit Has Expired R 1/70.7/Exceptions Allowing Extension of Time Limit R 1/70.7.1/Administrative Error Absolute Total Care will honor those authorizations. The benefit can be used to get more than 150 items - including vitamins, pain relievers, cold and allergy medicines, baby wipes, and diapers - at no cost . 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. 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. You will receive an acknowledgement letter within 5 business days, and we will send you a resolution within 90 calendar days. WellCare of North Carolina will begin to release medical payments to providers beginning July 6, 2021. We may apply a 14 day extension to your grievance resolution. ?-}++lz;.0U(_I]:3O'~3-~%-JM As of April 1, 2021, all WellCare of South Carolina Medicaid members will transfer to Absolute Total Care. * Password. Explains rules and state, line of business and CMS-specific regulations regarding 837P EDI transactions. 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. Timely filing limits vary. You can file the grievance yourself. WellCare offers participating providers EFT and ERA services at no charge through PaySpan Health. Learn more about how were supporting members and providers. All Paper Claim Submissions can be mailed to: WellCare Health Plans Awagandakami 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. Please use the From Date Institutional Statement Date. Professional and Institutional Encounter EDI transactions should be submitted to WellCare of South Carolina Medicaid with Payer ID 59354. 941w*)bF iLK\c;nF mhk} Addakam ditoy para kenka. A. State Health Plan State Claims P.O. Contact Wellcare Prime Provider Service at 1-855-735-4398 if you have questions. Reconsideration or Claim Disputes/Appeals: Please use the earliest From Date. To continue care with their current provider after the 90-day transition of care, the provider must agree to work with Absolute Total Care on the member's care and accept Absolute Total Care's payment rates. This must be done within 120 days from the date of Notice of Appeal Resolution you received from us. Will my existing WellCare patients be assigned to my Absolute Total Care Panel? How do I bill a professional submission with services spanning before and after 04/01/2021? You can get many of your Coronavirus-related questions answered here. Wellcare uses cookies. WellCare of South Carolina will be known as Absolute Total Care as of April 1, 2021. 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 uses cookies. 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. Register now at https://www.payspanhealth.comor contact PaySpan at providersupport@payspanhealth.com, or 877-331-7154. 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. 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. All billing requirements must be adher ed to by the provider in order to ensure timely processing of claims. You may do this in writing or in person. If Statement Range is March 14, 2021 through April 3, 2021, please send to WellCare. WellCare Medicare members are not affected by this change. 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. Here you will find the tools and resources you need to help manage your submission of claims and receipt of payments. For dates of service prior to April 1, 2021: All paper claim submissions can be mailed to: WellCare Health Plans 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. If you wish to use a representative, then he or she must complete an Appointment of Representative (AOR) statement. Q. They are called: State law allows you to make a grievance if you have any problems with us. You can file your appeal by calling or writing to us. Shop or Enroll in a Plan Frequently Asked Questions Find a Doctor Download Digital ID Card Welcome Allwell Members! Wellcare uses cookies. Only you or your authorizedrepresentative can ask for a State Fair Hearing. Absolute Total Care will honor all existing WellCare authorization approvals that include dates of service beyond March 31, 2021. 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. You and the person you choose to represent you must sign the AOR form. A. Search for primary care providers, hospitals, pharmacies, and more! WellCare has partnered with Change Healthcare as our preferred EDI Clearinghouse. A. Tampa, FL 33631-3372. More Information Need help? Box 31384 The timely filing limit is the time duration from service rendered to patients and submitting claims to the insurance companies. You now have access to a secure, quick way to electronically settle claims. We are simplifying Medicare so you can choose and use an affordable local plan that will help you achieve your best possible health. APPEALS, GRIEVANCES AND PROVIDER DISPUTES. The onlineProvider Manual represents the most up-to-date information on Absolute Total Cares Medicaid Plan, programs, policies, and procedures. We will notify you orally and in writing. The Medicare portion of the agreement will continue to function in its entirety as applicable. For dates of service on or after April 1, 2021: Absolute Total Care This gives members time to establish with a new provider in the network and ensure that they have continuity of care. Please use the From Date Institutional Statement Date. Pregnant members receiving care from an out-of-network Obstetrician can continue to see their current obstetrician until after the baby is born. Box 6000 Greenville, SC 29606. The way your providers or others act or treat you. South Carolina DEPARTMENT OF HEALTH AND HUMAN SERVICES Post Office Box 8206 Columbia, South Carolina 29202-8206 www.scdhhs.gov November 24, 2009 ALL . Tampa, FL 33631-3384. Kasapulam ti tulong? 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 do this: Be sure to ask us to continue your benefits within the 10 calendar day time frame. You can file an appeal if you do not agree with our decision. Earliest From Dates on or after April 1, 2021 should be filed to Absolute Total Care. 0 Our health insurance programs are committed to transforming the health of the community one individual at a time. Earliest From Dates 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. You can get many of your Coronavirus-related questions answered here. PROVIDERS NOTE:Please send Corrected Claims as normal submissions via electronic or paper. B^E{h#XYQv;[ny3Hha1yx4v.sBy jWacQzyL.kHhwtQ~35!Rh#)p+sj31LcC)4*Z:IWIG@WTD- )n,! %%EOF The second level review will follow the same process and procedure outlined for the initial review. Contact Wellcare Prime Provider Service at1-855-735-4398if youhave questions. endstream endobj startxref Or you can have someone file it for you. This includes providing assistance with accessing interpreter services and hearing impaired . By continuing to use our site, you agree to our Privacy Policy and Terms of Use. (This includes your PCP or another provider.) P.O. Q. This gives members time to establish with a new provider in the network and ensure that they have continuity of care. There is a lot of insurance that follows different time frames for claim submission. If you think you might have been exposed, contact a doctor immediately. 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. With the completion of this transaction, we have created a premier healthcare enterprise focused on government-sponsored healthcare programs. We will continue covering your medical services during your appeal request and State Fair Hearing if all of the following are meet. Members will receive a 90-day transition of care period if the member is receiving ongoing care and treatment. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. Members will receive a 90-day transition of care period if the member is receiving ongoing care and treatment. We understand that maintaining a healthy community starts with providing care to those who need it most. WellCare of South Carolinawants to ensure that claims are handled as efficiently as possible. 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 credentialing cycles will be shared with Absolute Total Care in order to reduce duplicative credentialing in the future. Date of Occurrence/DOSprior toApril 1, 2021: Processed by WellCare. Thanka kaa yoa Tufrbeau ingsnh ngetfu South Caralaita nouMa mpvd. To ask for hearing, call 1-800-763-9087 or write to: You also can make a request online using SCDHHS form at https://msp.scdhhs.gov/appeals/site-page/file-appeal. If you dont, we will have to deny your request. pst/!+ Y^Ynwb7tw,eI^ Claims submission, correspondence, and contact resources will stay the same for the Medicare line of business. Professional and Institutional Encounter EDI transactions should be submitted to WellCare of South Carolina Medicaid with Payer ID 59354. Q: What is Absolute Total Cares Transition/Continuity of Care Policy? Claim Filing Manual - First Choice by Select Health of South Carolina What will happen to my Participating Provider Agreement with WellCare after 4/1/2021? From Date Institutional Statement Dates on or after April 1, 2021 should be filed to Absolute Total Care. Date of Occurrence/DOSApril 1, 2021 and after: Processed by Absolute Total Care. Q. They must inform their vendor of AmeriHealth Caritas . Hearings are used when you were denied a service or only part of the service was approved. Absolute Total Care will honor those authorizations. Please see list of services that will require authorization during this time. P.O. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. For additional information, questions or concerns, please contact your local Provider Network Management Representative. Explains rules and state, line of business and CMS-specific regulations regarding 837I EDI transactions. We welcome Brokers who share our commitment to compliance and member satisfaction. Register now at https://www.payspanhealth.com or contact PaySpan at providersupport@payspanhealth.com, or 877-331-7154. A. DOS April 1, 2021 and after: Processed by Absolute Total Care. Q. With quality healthcare solutions, Ambetter from Absolute Total Care helps residents of South Carolina live better. The onlineProvider Manual represents the most up-to-date information on Wellcare Prime by Absolute Total Care (Medicare-Medicaid Plan), programs, policies, and procedures. For the latest COVID-19 news, visit the CDC. You may file your second level grievance review within 30 days of receiving your grievance decision letter. We will do this as quickly as possible as but no longer than 72-hours from the decision. 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.
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