A. How do I determine if a professional or an outpatient bill type institutional submission should be filed to WellCare or Absolute Total Care? 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. If you think you might have been exposed, contact a doctor immediately. The provider needs to contact Absolute Total Care to arrange continuing care. We have licensed clinicians available to speak with you and to connect you to the support you need to feel better. Explains rules and state, line of business and CMS-specific regulations regarding 837P EDI transactions. WellCare of South Carolina will be known as Absolute Total Care as of April 1, 2021. No, Absolute Total Care will continue to operate under the Absolute Total Care name. Box 600601 Columbia, SC 29260. Q. You can get many of your Coronavirus-related questions answered here. 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? As of April 1, 2021, WellCare will no longer be a separate plan option offered by South Carolina Healthy Connections Choices. Box 6000 Greenville, SC 29606. All dates of service prior to April 1, 2021 should be filed to WellCare of South Carolina. However, as of April 1, 2021, all WellCare of South Carolina Medicaid members will become Absolute Total Care members. 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. Symptoms are flu-like, including: Fever Coughing S< Search for primary care providers, hospitals, pharmacies, and more! A. hbbd``b`$= $ Written notice is not needed if your expedited appeal request is filed verbally. All dates of service prior to 4/1/2021 should be filed to WellCare of South Carolina. 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. People of all ages can be infected. Pregnant members receiving care from an out-of-network Obstetrician can continue to see their current obstetrician until after the baby is born. 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. Please use the From Date Institutional Statement Date. First Choice can accept claim submissions via paper or electronically (EDI). 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. Professional and Institutional Fee-For-Service EDI transactions should be submitted to WellCare of South Carolina Medicaid with Payer ID 14163. 0 Q. We try to make filing claims with us as easy as possible. How do I determine if an institutional inpatient bill type submission overlapping 4/1/2021 should be filed to WellCare or Absolute Total Care? If you dont, we will have to deny your request. N .7$* P!70 *I;Rox3 ] LS~. If your services are continued during an appeal or a hearing, you can keep getting them until: If the hearing is decided in your favor, well approve and pay for the care that is needed. hYnH~}9'I`@>cLq,&DYH"W~&eJx'"luWU]JDBFRJ!*SN(s'6# ^*dg4$SB7K4z:r6')baka+Raf4J=)l, _/jaSpao69&&_Ln=?/{:,'z .1J0|~jv4[eUN{:-gl! K'&hng?y},&X/|OzcJ@0PhDiO})9RA9tG%=|rBhHBz7 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 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. You may file your second level grievance review within 30 days of receiving your grievance decision letter. 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 . 3) Coordination of Benefits. Copyright 2023 Wellcare Health Plans, Inc. Clinical Laboratory Improvement Amendments (CLIA). To do so by phone, call Member Services at 1-888-588-9842 (TTY1-877-247-6272). (This includes your PCP or another provider.) In this section, we will explain how you can tell us about these concerns/grievances. Contact Wellcare Prime Provider Service at1-855-735-4398if youhave questions. 1,flQ*!WLOmsmz\D;I5BI,yA#z!vYQi5'fedREF40 b666q1(UtUJJ.i` (T/@E 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. 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. WellCare and Absolute Total Care Medicare plans will continue to operate under current brands, product names and provider contracts, until further notice. Wellcare uses cookies. Providers can begin requesting prior authorization from Absolute Total Care for dates of service on or after April 1, 2021 from Absolute Total Care on March 15, 2021. Providers can help facilitate timely claim payment by having an understanding of our processes and requirements. Claims Department Shop or Enroll in a Plan Frequently Asked Questions Find a Doctor Download Digital ID Card Welcome Allwell Members! Providers can help facilitate timely claim payment by having an understanding of our processes and requirements. Coronavirus Disease 2019 (COVID-19) causes respiratory illness in people and can spread from person to person. We expect this process to be seamless for our valued members and there will be no break in their coverage. Pregnant members receiving care from an out of network Obstetrician can continue to see their current Obstetrician until after the baby is born. Ancillary Claims Filing Reminders; ClaimsXten TM: Correct Coding Initiative Reference Guide; Inpatient Non-Reimbursable Charges/Unbundling Policy 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. 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. 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. Here are some guides we created to help you with claims filing. If an authorization is needed, you can log in to the Secure Provider Portalto submit and confirm authorizations. Wellcare uses cookies. To do this: You may request a State Fair Hearing at this address: South Carolina Department of Health Members can continue to receive services from their current WellCare provider as long as they remain covered under WellCare. Ambetter Timely Filing Limit of : 1) Initial Claims. Or you can have someone file it for you. #~0 I As of April 1, 2021, all WellCare of South Carolina Medicaid members will become Absolute Total Care members. Where should I submit claims for WellCare Medicaid members? z4M0(th`1Lf`M18c BIcJ[%4l JU2 _ s WellCare offers participating providers EFT and ERA services at no charge through PaySpan Health. You or your provider must call or fax us to ask for a fast appeal. Utilize interactive health and wellness tools to help you manage conditions, improve your health and save money. DOSApril 1, 2021 and after: Processed by Absolute Total Care. \{-w{,xI202100$0*bZf ,X AayhP3pYla" e 3G& `eoT#@ *;d State Health Plan State Claims P.O. WellCare of South Carolinawants to ensure that claims are handled as efficiently as possible. You can ask in writing for a State Fair Hearing (hearing, for short). You or your authorized representative will tell the hearing officer why you think we made the wrong decision. You will have a limited time to submit additional information for a fast appeal. A provider can act for a member in hearings with the member's written permission in advance. This manual sets forth the policies and procedures that providers participating in the Wellcare Prime network are required tofollow. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. Resources WellCare of South Carolina will be known as Absolute Total Care as of April 1, 2021. 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. For dates of service prior to April 1, 2021: All paper claim submissions can be mailed to: WellCare Health Plans This gives members time to establish with a new provider in the network and ensure that they have continuity of care. 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. Welcome to WellCare of South Carolina! 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. 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. For the latest COVID-19 news, visit the CDC. We would like to help your billing department get your EDI (claims and real time) transactions processed as efficiently as possible. We are committed to improving the quality of life of our millions of members, who often include some of our nations most vulnerable populations. If Statement Range is April 2, 2021 through April 10, 2021, please send to Absolute Total Care. The Claim Reconsideration process is an informal claim review, and is not a substitute for an appeal of a final agency decision. You and the person you choose to represent you must sign the AOR statement. The Medicare portion of the agreement will continue to function in its entirety as applicable. 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. Q. 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. Contact Wellcare Prime Provider Service at 1-855-735-4398 if you have questions. 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. South Carolina | Wellcare SOUTH CAROLINA Healthcare done well. Timely Filing Beginning October 1, 2020, the Timely Filing submission requirements specified in each Provider's Meridian Medicare contract will be enforced. If you request a hearing, the request must: A State Fair Hearing is a legal proceeding. Wellcare uses cookies. You can file your appeal by calling or writing to us. More Information Coronavirus (COVID-19) Federal Employee Program (FEP) Federal Employee Program P.O. WellCare Medicare members are not affected by this change. 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 Attn: Grievance Department Welcome to Wellcare By Allwell, a Medicare Advantage plan. Reimbursement Policies Q. Division of Appeals and Hearings We will also send you a letter with our decision within 72 hours from receiving your appeal. 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. 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. Our toll-free fax number is 1-877-297-3112. Molina Healthcare of Michigan, 100 W. Big Beaver Road, Suite 600 Attn: Claims, Troy, MI 48084-5209 Or Fax to: (248) 925-1768. You can file a grievance by calling or writing to us. 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. Member Appeals (Medical, Behavioral Health, and Pharmacy): You will need Adobe Reader to open PDFs on this site. endstream endobj startxref 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. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. Please use WellCare Payor ID 14163. 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 transfer to Absolute Total Care. It is called a "Notice of Adverse Benefit Determination" or "NABD." How do I join Absolute Total Cares provider network? Copyright 2023 Wellcare Health Plans, Inc. Absolute Total Care 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 Q. You can also have a video visit with a doctor using your phone or computer. Select Health Claims must be filed within 12 months from the date of service. They must inform their vendor of AmeriHealth Caritas . We understand that maintaining a healthy community starts with providing care to those who need it most. In South Carolina, WellCare and Absolute Total Care are joining to better serve you. Pharmacy services prior to April 1, 2021 must be requested from WellCare of South Carolina. Initial Claims: 120 Days from the Date of Service. How do I bill a professional submission with services spanning before and after 04/01/2021? hb```b``6``e`~ "@1V NB, To write us, send mail to: You can fax it too. Absolute Total Care will continue to offer Marketplace products under the Ambetter brand. Want to receive your payments faster to improve cash flow? Send your written appeal to: We must have your written consent before someone can file an appeal for you. 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. PROVIDERS NOTE:Please send Corrected Claims as normal submissions via electronic or paper. Contact Us Y0020_WCM_100876E Last Updated On: 10/1/2022 Q. Register now at https://www.payspanhealth.comor contact PaySpan at [email protected], or 877-331-7154. Professional and Institutional Fee-For-Service EDI transactions should be submitted to WellCare of South Carolina Medicaid with Payer ID 14163. Members will need to talk to their provider right away if they want to keep seeing him/her. We want to ensure that claims are handled as efficiently as possible. The state has also helped to set the rules for making a grievance. Tampa, FL 33631-3372. We are proud to announce that WellCare is now part of the Centene Family. We expect this process to be seamless for our valued members and there will be no break in their coverage. WellCare claims will be processed according to timely filing provisions in the providers WellCare Participating Provider Agreement. WellCare of South Carolina will be known as Absolute Total Care as of April 1, 2021. All Paper Claim Submissions can be mailed to: WellCare Health Plans 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. A. You will get a letter from us when any of these actions occur. This must be done within 120 days from the date of Notice of Appeal Resolution you received from us. WellCare Medicare Advantage Claims must be filed within 180 calendar days from the date of service. With the completion of this transaction, we have created a premier healthcare enterprise focused on government-sponsored healthcare programs. We will send you another letter with our decision within 90 days or sooner. Explains rules and state, line of business and CMS-specific regulations regarding 837P EDI transactions. What will happen to my Participating Provider Agreement with WellCare after 4/1/2021? 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. Tampa, FL 33631-3372. Claim Filing Manual - First Choice by Select Health of South Carolina WellCare of North Carolina will begin to release medical payments to providers beginning July 6, 2021. There is a lot of insurance that follows different time frames for claim submission. We are glad you joined our family! Here you will find the tools and resources you need to help manage your submission of claims and receipt of payments. Please contact our Provider Services Call Center at 1-888-898-7969. pst/!+ Y^Ynwb7tw,eI^ Providers interested in joining the Absolute Total Care Provider Network should submit a request to Network Development and Contracting via email at [email protected]. Your second-level review will be performed by person(s) not involved in the first review. Farmington, MO 63640-3821. We will give you information to help you get the most from your benefits and the services we provide. Our health insurance programs are committed to transforming the health of the community one individual at a time. We will notify you orally and in writing. 1096 0 obj <>stream Members will receive a 90-day transition of care period if the member is receiving ongoing care and treatment. You must file your appeal within 60 calendar days from the date on the NABD. Explains how to receive, load and send 834 EDI files for member information. April 1-April 3, 2021, please send to Absolute Total Care. An appeal is a request you can make when you do not agree with a decision we made about your care. A. Or it can be made if we take too long to make a care decision. 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. As of April 1, 2021, all WellCare of South Carolina Medicaid members will become Absolute Total Care members. ?-}++lz;.0U(_I]:3O'~3-~%-JM WellCare is the health care plan that puts you in control.

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