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Additionally, WellCare will have a migration section on their provider webpage publishing FAQs. With the completion of this transaction, we have created a premier healthcare enterprise focused on government-sponsored healthcare programs. 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. 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 By continuing to use our site, you agree to our Privacy Policy and Terms of Use. Select your topic and plan and click "Chat Now!" to chat with a live agent! Addakam ditoy para kenka. Resources We are proud to announce that WellCare is now part of the Centene Family. If Statement Range is April 2, 2021 through April 10, 2021, please send to Absolute Total Care. 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. 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. Providers interested in joining the Absolute Total Care vision network for routine vision services can contact Envolve Vision at 1-800-531-2818. To write us, send mail to: You can fax it too. If you need claim filing assistance, please contact your provider advocate. Members can continue to receive services from their current WellCare provider as long as they remain covered under WellCare. \{-w{,xI202100$0*bZf ,X AayhP3pYla" e 3G& `eoT#@ *;d P.O. Claims for services prior to April 1, 2021 should be filed to WellCare for processing. endstream endobj 1045 0 obj <>/Metadata 50 0 R/OpenAction 1046 0 R/Outlines 160 0 R/Pages 1042 0 R/StructTreeRoot 166 0 R/Type/Catalog/ViewerPreferences<>>> endobj 1046 0 obj <> endobj 1047 0 obj <>/Font<>/ProcSet[/PDF/Text/ImageC/ImageB/ImageI]/XObject<>>>/Rotate 0/StructParents 0/Tabs/S/TrimBox[0.0 0.0 612.0 792.0]/Type/Page>> endobj 1048 0 obj <>stream Q. This manual sets forth the policies and procedures that providers participating in the Wellcare Prime network are required tofollow. 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. What will happen to unresolved claims prior to the membership transfer? Q. Thanka kaa yoa Tufrbeau ingsnh ngetfu South Caralaita nouMa mpvd. 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 . Members will need to talk to their provider right away if they want to keep seeing him/her. 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. Wellcare wants to ensure that claims are handled as efficiently as possible. We expect this process to be seamless for our valued members and there will be no break in their coverage. 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 A. Please use the Earliest From Date. Wellcare uses cookies. For standard requests, if you call in your appeal, you must follow up with a written, signed one, within thirty calendar days. Pharmacy services prior to 4/1/2021 must be requested from WellCare South Carolina. Where should I submit claims for WellCare Medicaid members? You or your authorized representative will tell the hearing officer why you think we made the wrong decision. Claims will be processed according to timely filing provisions in the providers WellCare Participating Provider Agreement. Absolute Total Care will honor those authorizations. Our toll-free fax number is 1-877-297-3112. For additional information, questions or concerns, please contact your local Provider Network Management Representative. Q. Claim Filing Manual - First Choice by Select Health of South Carolina 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. Will Absolute Total Care continue to offer Medicare and Marketplace products? 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. From Date Institutional Statement Dates on or after April 1, 2021 should be filed to Absolute Total Care. 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. DOSApril 1, 2021 and after: Processed by Absolute Total Care. B^E{h#XYQv;[ny3Hha1yx4v.sBy jWacQzyL.kHhwtQ~35!Rh#)p+sj31LcC)4*Z:IWIG@WTD- )n,! You can file your appeal by calling or writing to us. Register now. This gives members time to establish with a new provider in the network and ensure that they have continuity of care. It will let you know we received your appeal. However, there will be no members accessing/assigned to the Medicaid portion of the agreement. Yes, Absolute Total Care and WellCare will continue to offer Medicare products under their current brands and product names, until further notice. 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. Contact Absolute Total Care Provider Service at1-866-433-6041if youhave questions. Download the free version of Adobe Reader. Send your written appeal to: We must have your written consent before someone can file an appeal for you. 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. APPEALS, GRIEVANCES AND PROVIDER DISPUTES. Welcome to WellCare of South Carolina! For general questions about claims submissions, call Provider Claims Services at 1-800-575-0418. Member Sign-In. A. Our call centers, including the nurse advice line, are currently experiencing high volume. Coronavirus Disease 2019 (COVID-19) causes respiratory illness in people and can spread from person to person. Provider can't require members to appoint them as a condition of getting services. 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. 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. Pharmacy services prior to April 1, 2021 must be requested from WellCare of South Carolina. Get an annual flu shot today. 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. Q. Claims will be processed according to timely filing provisions in the providers Absolute Total Care Participating Provider Agreement. Initial Claims: 120 Days from the Date of Service. WellCare claims will be processed according to timely filing provisions in the providers WellCare Participating Provider Agreement. For dates of service prior to April 1, 2021: All paper claim submissions can be mailed to: WellCare Health Plans 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 can file a grievance by calling or writing to us. 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. 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. How do I bill a professional submission with services spanning before and after 04/01/2021? We try to make filing claims with us as easy as possible. Shop or Enroll in a Plan Frequently Asked Questions Find a Doctor Download Digital ID Card Welcome Allwell Members! A. 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? P.O. Where should I submit claims for WellCare Medicaid members that transition to Absolute Total Care? From Date Institutional Statement Dates prior to April 1, 2021 should be filed to WellCare of South Carolina. Q. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. 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 is the health care plan that puts you in control. 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. If you file a grievance or an appeal, we must be fair. If you request a hearing, the request must: A State Fair Hearing is a legal proceeding. Copyright 2023 Wellcare Health Plans, Inc. P.O. 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). Instructions on how to submit a corrected or voided claim. Within five business days of getting your grievance, we will mail you a letter. endstream endobj startxref 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. If Statement Range is March 14, 2021 through April 3, 2021, please send to WellCare. 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. 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. Division of Appeals and Hearings Box 8206 Providers can help facilitate timely claim payment by having an understanding of our processes and requirements. We will continue covering your medical services during your appeal request and State Fair Hearing if all of the following are meet. In this section, we will explain how you can tell us about these concerns/grievances. Incorrect forms will not be considered and may lead to further delays in processing prior authorization requests. All dates of service prior to 4/1/2021 should be filed to WellCare of South Carolina. 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. 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. All billing requirements must be adher ed to by the provider in order to ensure timely processing of claims. 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? With quality healthcare solutions, Ambetter from Absolute Total Care helps residents of South Carolina live better. This includes providing assistance with accessing interpreter services and hearing impaired . Guides Filing Claims with WellCare. Absolute Total Care will honor those authorizations. 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. Members can continue to receive services from their current WellCare provider as long as they remain covered under WellCare. As of April 1, 2021, WellCare will no longer be a separate plan option offered by South Carolina Healthy Connections Choices. WellCare Medicare members are not affected by this change. However, as of April 1, 2021, all WellCare of South Carolina Medicaid members will become Absolute Total Care members. We will also send you a letter with our decision within 72 hours from receiving your appeal. You or your provider must call or fax us to ask for a fast appeal. Professional and Institutional Encounter EDI transactions should be submitted to WellCare of South Carolina Medicaid with Payer ID 59354. In South Carolina, WellCare and Absolute Total Care are joining to better serve you. Obstetrician care provided by an out-of-network obstetrician will be covered for pregnant members inclusive of postpartum care. 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. April 1-April 3, 2021, please send to Absolute Total Care. A. WellCare Medicare members are not affected by this change. Example of how to properly split claim that span the cutover date of April 1, 2021: Q. Will my existing WellCare patients be assigned to my Absolute Total Care Panel? More Information Need help? Reconsideration or Claim Disputes/Appeals: 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. How are WellCare Medicaid member authorizations being handled after April 1, 2021? You can file the grievance yourself. Additionally, WellCare will have a migration section on their provider page at publishing FAQs. As of April 1, 2021, all WellCare of South Carolina Medicaid members will transfer to Absolute Total Care. BlueCross BlueShield of South Carolina Piedmont Service Center P.O. Tampa, FL 33631-3384. WellCare of South Carolina will be known as Absolute Total Care as of April 1, 2021. 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. Ambetter Timely Filing Limit of : 1) Initial Claims. Q. A. The Medicare portion of the agreement will continue to function in its entirety as applicable. Explains rules and state, line of business and CMS-specific regulations regarding 837I EDI transactions. 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. 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. You must file your appeal within 60 calendar days from the date on the NABD. 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. As of April 1, 2021, all WellCare of South Carolina Medicaid members will become Absolute Total Care members. Wfu neebybfgnh bgWfulnybfgC South Carolina Medicaid Provider Resource Guide Thank you for being a star member of our provider team. We may apply a 14 day extension to your grievance resolution. Select Health Claims must be filed within 12 months from the date of service. Ambetter from Absolute Total Care - South Carolina. No, Absolute Total Care will continue to operate under the Absolute Total Care name.