Date of Occurrence/DOSprior toApril 1, 2021: Processed by WellCare. An appeal is a request you can make when you do not agree with a decision we made about your care. It will let you know we received your appeal. You can file an appeal if you do not agree with our decision. 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. Hearings are used when you were denied a service or only part of the service was approved. 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. As of April 1, 2021, all WellCare of South Carolina Medicaid members will become Absolute Total Care members. Providers can help facilitate timely claim payment by having an understanding of our processes and requirements. Learn how you can help keep yourself and others healthy. We may apply a 14 day extension to your grievance resolution. 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 WellCare of North Carolina will begin to release medical payments to providers beginning July 6, 2021. Coronavirus Disease 2019 (COVID-19) causes respiratory illness in people and can spread from person to person. The Medicare portion of the agreement will continue to function in its entirety as applicable. Only you or your authorizedrepresentative can ask for a State Fair Hearing. 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. 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. Instructions on how to submit a corrected or voided claim. 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. March 14-March 31, 2021, please send to WellCare. April 1-April 3, 2021, please send to Absolute Total Care. A. Our call centers, including the nurse advice line, are currently experiencing high volume. Providers are encouraged to visit the Provider Resources webpagefor manuals, forms, and resources related to claims submission, eligibility, prior authorization, and more. 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. 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. Within five business days of getting your grievance, we will mail you a letter. Members must have Medicaid to enroll. 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. Earliest From Dates on or after April 1, 2021 should be filed to Absolute Total Care. This manual sets forth the policies and procedures that providers participating in the Wellcare Prime network are required tofollow. 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? 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. Q. These materials are for informational purposes only. 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 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 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. 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. hb```b``6``e`~ "@1V
NB, 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 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. You can file your appeal by calling or writing to us. More Information Coronavirus (COVID-19) Explains how to receive, load and send 834 EDI files for member information. 1044 0 obj
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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. Provider can't require members to appoint them as a condition of getting services. Q. It can also be about a provider and/or a service. WellCare credentialing cycles will be shared with Absolute Total Care in order to reduce duplicative credentialing in the future. hbbd``b`$= $ As of April 1, 2021 Absolute Total Care, a Centene company, is now the health plan for South Carolina Medicaid members. Claims will be processed according to timely filing provisions in the providers WellCare Participating Provider Agreement. Download the free version of Adobe Reader. %%EOF
You can file the grievance yourself. DOS April 1, 2021 and after: Processed by Absolute Total Care. P.O. Providers can help facilitate timely claim payment by having an understanding of our processes and requirements. Earliest From Dates prior to 4/1/2021 should be filed to WellCare of South Carolina. Or it can be made if we take too long to make a care decision. A. For standard requests, if you call in your appeal, you must follow up with a written, signed one, within thirty calendar days. The Medicare portion of the agreement will continue to function in its entirety as applicable. 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. Utilize interactive health and wellness tools to help you manage conditions, improve your health and save money. A. Please use WellCare Payor ID 14163. You may do this in writing or in person. The Medicare portion of the agreement will continue to function in its entirety as applicable. How do I determine if an institutional inpatient bill type submission overlapping 4/1/2021 should be filed to WellCare or Absolute Total Care? 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. A. We expect this process to be seamless for our valued members, and there will be no break in their coverage. N .7$* P!70 *I;Rox3
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Claims for services prior to April 1, 2021 should be filed to WellCare for processing. This gives members time to establish with a new provider in the network and ensure that they have continuity of care. No, Absolute Total Care will continue to operate under the Absolute Total Care name. 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. %PDF-1.6
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Payments mailed to providers are subject to USPS mailing timeframes. Box 31224 Claims Submission, Correspondence and Contact Resources will stay the same for the Medicare line of business. We are glad you joined our family! Earliest From Dates on or after 4/1/2021 should be filed to Absolute Total Care. Our health insurance programs are committed to transforming the health of the community one individual at a time. and Human Services South Carolina DEPARTMENT OF HEALTH AND HUMAN SERVICES Post Office Box 8206 Columbia, South Carolina 29202-8206 www.scdhhs.gov November 24, 2009 ALL . All dates of service on or after April 1, 2021 should be filed to Absolute Total Care. With the completion of this transaction, we have created a premier healthcare enterprise focused on government-sponsored healthcare programs. Reimbursement Policies Payments mailed to providers are subject to USPS mailing timeframes. There is a lot of insurance that follows different time frames for claim submission. We're here for you. If at any time you need help filing one, call us. WellCare and Absolute Total Care Medicare plans will continue to operate under current brands, product names and provider contracts, until further notice. If an authorization is needed, you can log in to the Secure Provider Portal at absolutetotalcare.com to submit and confirm authorizations. 8h} \x p`03
1z`@+`~70 G ~Ws5Puick79,4 ,O5@?O-Gr'|5Oj:v6/` Box 600601 Columbia, SC 29260. Claims Department As of April 1, 2021, WellCare will no longer be a separate plan option offered by South Carolina Healthy Connections Choices. Send your written appeal to: We must have your written consent before someone can file an appeal for you. Register now at https://www.payspanhealth.com or contact PaySpan at providersupport@payspanhealth.com, or 877-331-7154. 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). Explains rules and state, line of business and CMS-specific regulations regarding 837I EDI transactions. 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. Molina Healthcare of Michigan, 100 W. Big Beaver Road, Suite 600 Attn: Claims, Troy, MI 48084-5209 Or Fax to: (248) 925-1768. A provider can act for a member in hearings with the member's written permission in advance. P.O. Guides Filing Claims with WellCare. Welcome to WellCare of South Carolina! We must have your written permission before someone can file a grievance for you. Q. Absolute Total Care will honor those authorizations. 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. A. 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. Q. 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. This gives members time to establish with a new provider in the network and ensure that they have continuity of care. Obstetrician care provided by an out-of-network obstetrician will be covered for pregnant members inclusive of postpartum care. Contact Absolute Total Care Provider Service at1-866-433-6041if youhave questions. Wellcare wants to ensure that claims are handled as efficiently as possible. A. People of all ages can be infected. Date of Occurrence/DOSApril 1, 2021 and after: Processed by Absolute Total Care. To do this: South Carolina | Wellcare SOUTH CAROLINA Healthcare done well. 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. The provider needs to contact Absolute Total Care to arrange continuing care. Farmington, MO 63640-3821. 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. You will need Adobe Reader to open PDFs on this site. In South Carolina, WellCare and Absolute Total Care are joining to better serve you. The participating provider agreement with WellCare will remain in-place after April 1, 2021. 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 or your provider must call or fax us to ask for a fast appeal. ?-}++lz;.0U(_I]:3O'~3-~%-JM Providers are encouraged to visit the Provider Resources webpageformanuals, forms, clinical policies, payment policies, provider news and resources related to claims submission, eligibility, prior authorization and more. Tampa, FL 33631-3372. This includes providing assistance with accessing interpreter services and hearing impaired . Will my existing WellCare patients be assigned to my Absolute Total Care Panel? Obstetrician care provided by an out of network Obstetrician will be covered for pregnant members inclusive of post-partum 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, 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. A. 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. 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.
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, Shortened Notification of Pregnancy (NOP) Provider Form (PDF), Notification of Pregnancy (NOP) Provider Form (PDF), Pregnancy Incentive Reimbursement Form (PDF), SCDHHS Form 1716 - Request for Medicaid ID Number - Infant (PDF), Member Appointment of Authorized Representative Form (PDF), SCDHHS Hospice Election/Enrollment Forms (PDF), Inpatient Prior Authorization Fax Form (PDF), Outpatient Prior Authorization Fax Form (PDF), SCDHHS Certificate of Medical Necessity (CMN) for Oxygen (PDF), Sick and Well Visit Reimbursement Letter (PDF), Claim Adjustments, Reconsiderations, and Disputes Provider Education (PDF), Obstetrical (OB) Incentive Programs (PDF), Provider Portal Enhancements: Claim Reconsideration and Denial Explanations (PDF), Outpatient Prior Authorization Form (PDF), Medicare Prescription Drug Coverage Determination Form (PDF), Authorization to Use and/or Disclose Health Information (PDF), Revocation of Authorization to Use and/or Disclose Health Information (PDF), Behavioral Health Psychological or Neuropsychological Testing Authorization Request Form (PDF), Electroconvulsive Therapy (ECT) Authorization Request Form (PDF), Behavioral Health Outpatient Treatment Request Form (PDF), Transitional Care Management Services Fact Sheet (PDF), Expedited Prior Authorization Request FAQ (PDF), Balance Billing Quick Reference Guide (PDF), 2021 Prior Authorization List Part B Appendix A (PDF), Bi-Annual Prior Authorization Update (PDF), 2021 Bi-Annual Prior Authorization Update Effective 8/1/21 (PDF), 2021 List of Covered Drugs (Formulary) Changes (PDF), New Century Health Implementation Notification (PDF), 2022 Wellcare by Allwell Provider Manual (PDF), Provider Reconsideration/Dispute Form (PDF), Behavioral Health Neuropsychological Testing Authorization Request Form (PDF), Behavioral Health Outpatient Treatement Request Form (PDF), Behavioral Health Electroconvulsive Therapy (ECT) Authorization Request Form (PDF), Electronic Funds Transfer (ETF) Features (PDF), 2021 List of Covered Drugs (Formulary) DSNP Changes (PDF), 2021 List of Covered Drugs (Formulary) HMO Changes (PDF). The state has also helped to set the rules for making a grievance. Absolute Total Care will honor those authorizations. Kasapulam ti tulong? Box 31224 For general questions about claims submissions, call Provider Claims Services at 1-800-575-0418. Claims will be processed according to timely filing provisions in the providers Absolute Total Care Participating Provider Agreement. 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. Division of Appeals and Hearings Providers can help facilitate timely claim payment by having an understanding of our processes and requirements. Absolute Total Care will continue to offer Marketplace products under the Ambetter brand. With quality healthcare solutions, Ambetter from Absolute Total Care helps residents of South Carolina live better. The hearing officer will decide whether our decision was right or wrong. DOSApril 1, 2021 and after: Processed by Absolute Total Care. Ambetter Timely Filing Limit of : 1) Initial Claims. WellCare understands that having access to the right tools can help you and your staff streamline day-to-day administrative tasks. Q: What is Absolute Total Cares Transition/Continuity of Care Policy? Prior authorizations issued by WellCare for dates of service on or after April 1, 2021 will transfer with the members eligibility to Absolute Total Care. Instructions on how to submit a corrected or voided claim. For the latest COVID-19 news, visit the CDC. Members will receive a 90-day transition of care period if the member is receiving ongoing care and treatment. Download the free version of Adobe Reader. Explains rules and state, line of business and CMS-specific regulations regarding 837P EDI transactions. 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.