To do so by phone, call Member Services at 1-888-588-9842 (TTY1-877-247-6272). Reimbursement Policies WellCare of North Carolina partners with providers to develop and deliver high-quality, cost-effective health care solutions. In South Carolina, WellCare and Absolute Total Care are joining to better serve you. Tampa, FL 33631-3384. We expect this process to be seamless for our valued members, and there will be no break in their coverage. 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 glad you joined our family! Payments mailed to providers are subject to USPS mailing timeframes. WellCare Medicare Advantage Claims must be filed within 180 calendar days from the date of service. Copyright 2023 Wellcare Health Plans, Inc. The provider needs to contact Absolute Total Care to arrange continuing care. To do this: March 14-March 31, 2021, please send to WellCare. The hearing officer will decide whether our decision was right or wrong. Claims Department South Carolina | Wellcare SOUTH CAROLINA Healthcare done well. 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. Box 8206 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. Hearings are used when you were denied a service or only part of the service was approved. * Password. You can ask in writing for a State Fair Hearing (hearing, for short). Examples: If Statement Range is March 14, 2021 through April 3, 2021, please send to WellCare. 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. Instructions on how to submit a corrected or voided claim. Providers can help facilitate timely claim payment by having an understanding of our processes and requirements. A. We will call you with our decision if we decide you need a fast appeal. Please use WellCare Payor ID 14163. If you are unable to view PDFs, please download Adobe Reader. 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. 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. WellCare and Absolute Total Care Medicare plans will continue to operate under current brands, product names and provider contracts, until further notice. 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. Search for primary care providers, hospitals, pharmacies, and more! It can also be about a provider and/or a service. You can file an appeal if you do not agree with our decision. Addakam ditoy para kenka. Providers are encouraged to visit the Provider Resources webpagefor manuals, forms, and resources related to claims submission, eligibility, prior authorization, and more. Claims will be processed according to timely filing provisions in the providers WellCare Participating Provider Agreement. hb```b``6``e`~ "@1V NB, 1096 0 obj <>stream A. #~0 I L]4(f4/pn~YTZSp-5/O*F)e~p:a6o{x8r 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. 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 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. 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. Q. A. WellCare credentialing cycles will be shared with Absolute Total Care in order to reduce duplicative credentialing in the future. 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. Please be sure to use the correct line of business prior authorization form for prior authorization requests. 3) Coordination of Benefits. However, there will be no members accessing/assigned to the Medicaid portion of the agreement. 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. Utilize interactive health and wellness tools to help you manage conditions, improve your health and save money. This must be done within 120 days from the date of Notice of Appeal Resolution you received from us. Absolute Total Care will honor those authorizations. We process check runs daily, with the exception of Sundays, National Holidays, and the last day of the month. Or you can have someone file it for you. We must have your written permission before someone can file a grievance for you. WellCare of South Carolina will be known as Absolute Total Care as of April 1, 2021. You can ask for a State Fair Hearing after we make our appeal decision. Additionally, WellCare will have a migration section on their provider webpage publishing FAQs. 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. Earliest From Dates on or after 4/1/2021 should be filed to Absolute Total Care. Our toll-free fax number is 1-877-297-3112. To write us, send mail to: You can fax it too. P.O. Additionally, WellCare will have a migration section on their provider page at publishing FAQs. If you file a grievance or an appeal, we must be fair. We will also send you a letter with our decision within 72 hours from receiving your appeal. These materials are for informational purposes only. Call us to get this form. Will Absolute Total Care continue to offer Medicare and Marketplace products? 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. WellCare credentialing cycles will be shared with Absolute Total Care in order to reduce duplicative credentialing in the future. 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. Your second-level review will be performed by person(s) not involved in the first review. WellCare understands that having access to the right tools can help you and your staff streamline day-to-day administrative tasks. 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. 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. You can file a grievance by calling or writing to us. The annual flu vaccine helps prevent the flu.Protect yourself and those around you. Check out the Interoperability Page to learn more. S< A. Q. Q. A. Member Appeals (Medical, Behavioral Health, and Pharmacy): You will need Adobe Reader to open PDFs on this site. Absolute Total Care A. 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. Learn how you can help keep yourself and others healthy. Overview & Resources WellCare of North Carolina partners with providers to develop and deliver high-quality, cost-effective health care solutions. How will credentialing/recredentialing be handled by Absolute Total Care if a provider was recently credentialed/recredentialed by WellCare? As of April 1, 2021, all WellCare of South Carolina Medicaid members will become Absolute Total Care members. Box 600601 Columbia, SC 29260. The provider needs to contact Absolute Total Care to arrange continuing care. Box 3050 N .7$* P!70 *I;Rox3 ] LS~. Q: What is Absolute Total Cares Transition/Continuity of Care Policy? Claims for services prior to April 1, 2021 should be filed to WellCare for processing. Q. Keep yourself informed about Coronavirus (COVID-19.) 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). By continuing to use our site, you agree to our Privacy Policy and Terms of Use. 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? As of April 1, 2021 Absolute Total Care, a Centene company, is now the health plan for South Carolina Medicaid members. Absolute Total Care will honor all existing WellCare authorization approvals that include dates of service beyond March 31, 2021. Awagandakami 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. Q. Obstetrician care provided by an out-of-network obstetrician will be covered for pregnant members inclusive of postpartum care. To avoid rejections please split the services into two separate claim submissions. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. 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. and Human Services Q. Welcome to Wellcare By Allwell, a Medicare Advantage plan. It will let you know we received your appeal. 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. 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. With the completion of this transaction, we have created a premier healthcare enterprise focused on government-sponsored healthcare programs. DOS prior to April 1, 2021: Processed by WellCare. Explains rules and state, line of business and CMS-specific regulations regarding 837I EDI transactions. Refer to your particular provider type program chapter for clarification. 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. However, as of April 1, 2021, all WellCare of South Carolina Medicaid members will become Absolute Total Care members. The onlineProvider Manual represents the most up-to-date information on Wellcare Prime by Absolute Total Care (Medicare-Medicaid Plan), programs, policies, and procedures. A provider can act for a member in hearings with the member's written permission in advance. Provider can't require members to appoint them as a condition of getting services. Wfu neebybfgnh bgWfulnybfgC South Carolina Medicaid Provider Resource Guide Thank you for being a star member of our provider team. We comply with applicable Federal civil rights laws and do not discriminate on the basis of race, color, national origin, age, sex, or disability. 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. A. Member Sign-In. Will Absolute Total Care change its name to WellCare? 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 We are proud to announce that WellCare is now part of the Centene Family. These SNP plans provide benefits beyond Original Medicare, and may include transportation to medical appointments and vision exams. 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. Members will receive a 90-day transition of care period if the member is receiving ongoing care and treatment. 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. You or your provider must call or fax us to ask for a fast appeal. Always verify timely filing requirements with the third party payor. 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. 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. To do this: Be sure to ask us to continue your benefits within the 10 calendar day time frame. Finding a doctor is quick and easy. Resources More Information Coronavirus (COVID-19) By continuing to use our site, you agree to our Privacy Policy and Terms of Use. UnitedHealthcare Dual Complete Special Needs Plan UnitedHealthcare Dual Complete Special Needs Plans (SNP) offer benefits for people with both Medicare and Medicaid. A grievance is when you tell us about a concern you have with our plan. Explains rules and state, line of business and CMS-specific regulations regarding 837P EDI transactions. If you need claim filing assistance, please contact your provider advocate. 1,flQ*!WLOmsmz\D;I5BI,yA#z!vYQi5'fedREF40 b666q1(UtUJJ.i` (T/@E 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. 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. 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. Wellcare uses cookies. 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. As of April 1, 2021, all WellCare of South Carolina Medicaid members will transfer to Absolute Total Care. Tampa, FL 33631-3372. However, there will be no members accessing/assigned to the Medicaid portion of the agreement. A. Explains rules and state, line of business and CMS-specific regulations regarding 837P EDI transactions. This manual sets forth the policies and procedures that providers participating in the Wellcare Prime network are required tofollow. We will do this as quickly as possible as but no longer than 72-hours from the decision. An appeal is a request you can make when you do not agree with a decision we made about your care. For dates of service on or after April 1, 2021: Absolute Total Care By continuing to use our site, you agree to our Privacy Policy and Terms of Use. Coronavirus Disease 2019 (COVID-19) causes respiratory illness in people and can spread from person to person. 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. An appeal may be filed within 60 calendar days from the date on the Adverse Benefit Determination Notice. The Claim Reconsideration process is an informal claim review, and is not a substitute for an appeal of a final agency decision. 2023 Medicare and PDP Compare Plans and Enroll Now. 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. As of April 1, 2021, all WellCare of South Carolina Medicaid members will transfer to Absolute Total Care. We cannot disenroll you from our plan or treat you differently. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. Division of Appeals and Hearings 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. Professional and Institutional Fee-For-Service EDI transactions should be submitted to WellCare of South Carolina Medicaid with Payer ID 14163. You and the person you choose to represent you must sign the AOR form. We will notify you orally and in writing. Claims Submission, Correspondence and Contact Resources will stay the same for the Medicare line of business. At the hearing, well explain why we made our decision. We try to make filing claims with us as easy as possible. Outpatient Prior Authorization Form (PDF) Inpatient Prior Authorization Form (PDF) 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. Tampa, FL 33631-3372. Exceptions to the one-year time limit: a) Medicare Cost Sharing Claims . Q. Download the free version of Adobe Reader. A. Register now at https://www.payspanhealth.comor contact PaySpan at providersupport@payspanhealth.com, or 877-331-7154. 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? Guides Filing Claims with WellCare. This manual sets forth the policies and procedures that providers participating in the Absolute Total Carenetwork are required tofollow. Wellcare uses cookies. With the completion of this transaction, we have created a premier healthcare enterprise focused on government-sponsored healthcare programs. First Choice can accept claim submissions via paper or electronically (EDI). 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. For additional information, questions or concerns, please contact your local Provider Network Management Representative. North Carolina PHP Billing Guidance for Local W Code. If Statement Range is April 2, 2021 through April 10, 2021, please send to Absolute Total Care. (This includes your PCP or another provider.) Earliest From Dates prior to April 1, 2021 should be filed to WellCare of South Carolina. From Date Institutional Statement Dates prior to 4/1/2021 should be filed to WellCare of South Carolina. hbbd``b`$= $ Timely filing is when you file a claim within a payer-determined time limit. You will have a limited time to submit additional information for a fast appeal. 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. 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 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. Effective January 1, 2015 the South Carolina Department of Health and Human Services (SCDHHS) will implement a Claim Reconsideration Policy. From Date Institutional Statement Dates prior to April 1, 2021 should be filed to WellCare of South Carolina. WellCare Medicare members are not affected by this change. From Date Institutional Statement Dates on or after 4/1/2021 should be filed to Absolute Total Care. For standard requests, if you call in your appeal, you must follow up with a written, signed one, within thirty calendar days. Q. 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. 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. How do I join Absolute Total Cares provider network?
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