Hearings are used when you were denied a service or only part of the service was approved. 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. ?-}++lz;.0U(_I]:3O'~3-~%-JM 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. You or your authorized representative can review the information we used to make our decision. 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. Professional and Institutional Encounter EDI transactions should be submitted to WellCare of South Carolina Medicaid with Payer ID 59354. Box 8206 For general questions about claims submissions, call Provider Claims Services at 1-800-575-0418. It can also be about a provider and/or a service. Q. 2) Reconsideration or Claim disputes/Appeals. For the latest COVID-19 news, visit the CDC. Examples: If Statement Range is March 14, 2021 through April 3, 2021, please send to WellCare. Forms. 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. APPEALS, GRIEVANCES AND PROVIDER DISPUTES. * Username. The annual flu vaccine helps prevent the flu. 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. pst/!+ Y^Ynwb7tw,eI^ 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. Section 1: General Information. The Claim Reconsideration process is an informal claim review, and is not a substitute for an appeal of a final agency decision. Instructions on how to submit a corrected or voided claim. Learn how you can help keep yourself and others healthy. PROVIDERS NOTE:Please send Corrected Claims as normal submissions via electronic or paper. 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. Q. 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. WellCare of South Carolina will be known as Absolute Total Care as of April 1, 2021. Providers are encouraged to visit the Provider Resources page at absolutetotalcare.com for manuals, forms and resources related to claims submission, eligibility, prior authorization and more. 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 Initial Claims: 120 Days from the Date of Service. If at any time you need help filing one, call us. With the completion of this transaction, we have created a premier healthcare enterprise focused on government-sponsored healthcare programs. 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. Box 3050 Absolute Total Care will honor all existing WellCare authorization approvals that include dates of service beyond March 31, 2021. Box 31224 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 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. Columbia, SC 29202-8206. How do I join Absolute Total Cares provider network? Claims for services prior to April 1, 2021 should be filed to WellCare for processing. Reconsideration or Claim Disputes/Appeals: Q. Forgot Your Password? Timely filing limits vary. 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. All dates of service prior to April 1, 2021 should be filed to WellCare of South Carolina. 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). However, there will be no members accessing/assigned to the Medicaid portion of the agreement. You will have a limited time to submit additional information for a fast appeal. Examples of good cause include, but are not limited to, the following: We will send you a letter within five business days of getting your appeal. WellCare and Absolute Total Care Medicare plans will continue to operate under current brands, product names and provider contracts, until further notice. Providers interested in joining the Absolute Total Care Provider Network should submit a request to Network Development and Contracting via email at. 1096 0 obj
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Will Absolute Total Care change its name to WellCare? As of April 1, 2021, WellCare will no longer be a separate plan option offered by South Carolina Healthy Connections Choices. Select Health Claims must be filed within 12 months from the date of service. Explains rules and state, line of business and CMS-specific regulations regarding 837P EDI transactions. From Date Institutional Statement Dates prior to April 1, 2021 should be filed to WellCare of South Carolina. 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. This must be done within 120 days from the date of Notice of Appeal Resolution you received from us. Earliest From Dates on or after April 1, 2021 should be filed to Absolute Total Care. Copyright 2023 Wellcare Health Plans, Inc. Clinical Laboratory Improvement Amendments (CLIA). WellCare of South Carolinawants to ensure that claims are handled as efficiently as possible. 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. WellCare claims will be processed according to timely filing provisions in the providers WellCare Participating Provider Agreement. These grievances may be about: The state of South Carolina allows members to file a grievance at anytime from the event that caused the dissatisfaction. Our toll-free fax number is 1-877-297-3112. Contact Us Y0020_WCM_100876E Last Updated On: 10/1/2022 Additionally, WellCare will have a migration section on their provider page at publishing FAQs. It is 30 days to 1 year and more and depends on . If an authorization is needed, you can log in to the Secure Provider Portal at absolutetotalcare.com to submit and confirm authorizations. To avoid rejections please split the services into two separate claim submissions. If an authorization is needed, you can log in to the Secure Provider Portalto submit and confirm authorizations. We want to ensure that claims are handled as efficiently as possible. From Date Institutional Statement Dates on or after 4/1/2021 should be filed to Absolute Total Care. Please Explore the Site and Get To Know Us. We will notify you orally and in writing. endstream
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Payments mailed to providers are subject to USPS mailing timeframes. From Date Institutional Statement Dates on or after April 1, 2021 should be filed to Absolute Total Care. Claims for services prior to April 1, 2021 should be filed to WellCare for processing. 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. Farmington, MO 63640-3821. We understand that maintaining a healthy community starts with providing care to those who need it most. We expect this process to be seamless for our valued members, and there will be no break in their coverage. 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. 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. 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. An authorized representative is someone you select to act on the behalf of a member to assist them through the appeals process. Professional and Institutional Fee-For-Service EDI transactions should be submitted to WellCare of South Carolina Medicaid with Payer ID 14163. 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. Wellcare uses cookies. Register now at https://www.payspanhealth.com or contact PaySpan at providersupport@payspanhealth.com, or 877-331-7154. March 14-March 31, 2021, please send to WellCare. Learn more about how were supporting members and providers. We cannot disenroll you from our plan or treat you differently. 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. hbbd``b`$= $ WellCare of North Carolina partners with providers to develop and deliver high-quality, cost-effective health care solutions. Will Absolute Total Care continue to offer Medicare and Marketplace products? Explains how to receive, load and send 834 EDI files for member information. 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, WellCare will no longer be a separate plan option offered by South Carolina Healthy Connections Choices. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. If you dont, we will have to deny your request. This includes providing assistance with accessing interpreter services and hearing impaired . Medicaid Claims Payment Policies How do I determine if an institutional inpatient bill type submission overlapping 4/1/2021 should be filed to WellCare or Absolute Total Care? WellCare Medicare members are not affected by this change. Member Appeals (Medical, Behavioral Health, and Pharmacy): You will need Adobe Reader to open PDFs on this site. and Human Services Copyright 2023 Wellcare Health Plans, Inc. 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. As a member you may request a 14 day extension of your grievance, you may do so by calling Member Services at 1-888-588-9842 (TTY 1-877-247-6272) or You may send your request for extension in writing to: WellCare Health Plans All billing requirements must be adher ed to by the provider in order to ensure timely processing of claims. We will continue covering your medical services during your appeal request and State Fair Hearing if all of the following are meet. You, your friend, a relative, legal counsel or other spokesperson who has your written consent may ask for a State Fair Hearing. Explains rules and state, line of business and CMS-specific regulations regarding 837P EDI transactions. As of April 1, 2021, all WellCare of South Carolina Medicaid members will transfer to 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. Where should I submit claims for WellCare Medicaid members? Contact Wellcare Prime Provider Service at 1-855-735-4398 if you have questions. Get an annual flu shot today. Written notice is not needed if your expedited appeal request is filed verbally. 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. This gives members time to establish with a new provider in the network and ensure that they have continuity of care. 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. 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. Member Sign-In. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. Q. Welcome to WellCare Provider Login Contact Us Join Our Network Medicaid Medicare Tools News and Education AcariaHealth Specialty Pharmacy Pharmacy Forms Request for Drug Coverage Request to Review Drug Coverage Denial . A. 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. Providers can help facilitate timely claim payment by having an understanding of our processes and requirements. However, as of April 1, 2021, all WellCare of South Carolina Medicaid members will become Absolute Total Care members. WellCare of South Carolina will be known as Absolute Total Care as of April 1, 2021. Q. South Carolina Department of Health and Human Services Division of Appeals and Hearings P.O. 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 current information, visit the Absolute Total Care website. No, Absolute Total Care will continue to operate under the Absolute Total Care name. 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.