A. Ancillary Claims Filing Reminders; ClaimsXten TM: Correct Coding Initiative Reference Guide; Inpatient Non-Reimbursable Charges/Unbundling Policy Copyright 2023 Wellcare Health Plans, Inc. Clinical Laboratory Improvement Amendments (CLIA). No, Absolute Total Care will continue to operate under the Absolute Total Care name. The participating provider agreement with WellCare will remain in-place after April 1, 2021. A. WellCare credentialing cycles will be shared with Absolute Total Care in order to reduce duplicative credentialing in the future. Professional and Institutional Encounter EDI transactions should be submitted to WellCare of South Carolina Medicaid with Payer ID 59354. You will receive an acknowledgement letter within 5 business days, and we will send you a resolution within 90 calendar days. South Carolina | Wellcare SOUTH CAROLINA Healthcare done well. We try to make filing claims with us as easy as possible. 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. Payments mailed to providers are subject to USPS mailing timeframes. Know the facts about Coronavirus (COVID-19) Our call centers, including the nurse advice line, are currently experiencing high volume. An appeal is a request you can make when you do not agree with a decision we made about your care. Explains how to receive, load and send 834 EDI files for member information. We will notify you orally and in writing. Member Sign-In. Box 8206 How will credentialing/recredentialing be handled by Absolute Total Care if a provider was recently credentialed/recredentialed by WellCare? You must file your appeal within 60 calendar days from the date on the NABD. There is a lot of insurance that follows different time frames for claim submission. 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. * Password. With the completion of this transaction, we have created a premier healthcare enterprise focused on government-sponsored healthcare programs. WellCare of South Carolina will be known as Absolute Total Care as of April 1, 2021. Will Absolute Total Care continue to offer Medicare and Marketplace products? 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. Paper Claim Submission Submit paper claims to: WellCare Health Plans Electronic Claim Submission To initiate electronic claims, both in-network and out-of-network providers should contact their practice management software vendor or EDI software vendor. For general questions about claims submissions, call Provider Claims Services at 1-800-575-0418. 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. Register now at https://www.payspanhealth.comor contact PaySpan at providersupport@payspanhealth.com, or 877-331-7154. 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. Claims will be processed according to timely filing provisions in the providers Absolute Total Care Participating Provider Agreement. Symptoms are flu-like, including: Fever Coughing P.O. People of all ages can be infected. Members can continue to receive services from their current WellCare provider as long as they remain covered under WellCare. 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. We expect this process to be seamless for our valued members, and there will be no break in their coverage. Reminder: It is important that providers check eligibility prior to providing services as members can potentially change plans prior to April 1, 2021 if they are in the annual choice period. Within five business days of getting your grievance, we will mail you a letter. 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). With the completion of this transaction, we have created a premier healthcare enterprise focused on government-sponsored healthcare programs. Effective January 1, 2015 the South Carolina Department of Health and Human Services (SCDHHS) will implement a Claim Reconsideration Policy. Call us to get this form. If an authorization is needed, you can log in to the Secure Provider Portalto submit and confirm authorizations. Learn how you can help keep yourself and others healthy. You can file your appeal by calling or writing to us. South Carolina Department of Health and Human Services Division of Appeals and Hearings P.O. From Date Institutional Statement Dates prior to April 1, 2021 should be filed to WellCare of South Carolina. Additionally, WellCare will have a migration section on their provider page at publishing FAQs. Here you will find the tools and resources you need to help manage your submission of claims and receipt of payments. 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. For the latest COVID-19 news, visit the CDC. Can I continue to see my current WellCare members? An appeal may be filed within 60 calendar days from the date on the Adverse Benefit Determination 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. For dates of service on or after 4/1/2021: 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. 2023 Medicare and PDP Compare Plans and Enroll Now. The onlineProvider Manual represents the most up-to-date information on Absolute Total Cares Medicaid Plan, programs, policies, and procedures. A. If you think you might have been exposed, contact a doctor immediately. 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. 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. Molina Healthcare of Michigan, 100 W. Big Beaver Road, Suite 600 Attn: Claims, Troy, MI 48084-5209 Or Fax to: (248) 925-1768. It is 30 days to 1 year and more and depends on . Earliest From Dates prior to 4/1/2021 should be filed to WellCare of South Carolina. 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. You will have a limited time to submit additional information for a fast appeal. Please contact our Provider Services Call Center at 1-888-898-7969. 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. Absolute Total Care will utilize credentialing cycles from WellCare and Absolute Total Care so that providers will only need to recredential once every three years. All Paper Claim Submissions can be mailed to: WellCare Health Plans Our call centers, including the nurse advice line, are currently experiencing high volume. We expect this process to be seamless for our valued members, and there will be no break in their coverage. Search for primary care providers, hospitals, pharmacies, and more! We expect this process to be seamless for our valued members and there will be no break in their coverage. Claims will be processed according to timely filing provisions in the providers WellCare Participating Provider Agreement. A. We may apply a 14 day extension to your grievance resolution. 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. 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 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. Farmington, MO 63640-3821. We have licensed clinicians available to speak with you and to connect you to the support you need to feel better. If you need claim filing assistance, please contact your provider advocate. The rules include what we must do when we get a grievance. You can make three types of grievances. To avoid rejections please split the services into two separate claim submissions. As of April 1, 2021, all WellCare of South Carolina Medicaid members will become Absolute Total Care members. In South Carolina, WellCare and Absolute Total Care are joining to better serve you. Explains rules and state, line of business and CMS-specific regulations regarding 837P EDI transactions. Additionally, WellCare will have a migration section on their provider webpage publishing FAQs. 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. $8v + Yu @bAD`K@8m.`:DPeV @l March 14-March 31, 2021, please send to WellCare. Division of Appeals and Hearings 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. As of April 1, 2021, all WellCare of South Carolina Medicaid members will become Absolute Total Care members. The timely filing limit is the time duration from service rendered to patients and submitting claims to the insurance companies. Click below for more information from Absolute Total Care: You are now able to view your health information from a third-party app on a mobile device or PC! We comply with applicable Federal civil rights laws and do not discriminate on the basis of race, color, national origin, age, sex, or disability. Wellcare uses cookies. You may request a State Fair Hearing at this address: South Carolina Department of Health However, as of April 1, 2021, all WellCare of South Carolina Medicaid members will become Absolute Total Care members. At the hearing, well explain why we made our decision. We are glad you joined our family! Outpatient Prior Authorization Form (PDF) Inpatient Prior Authorization Form (PDF) Providers can help facilitate timely claim payment by having an understanding of our processes and requirements. Providers can help facilitate timely claim payment by having an understanding of our processes and requirements. 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. More Information Need help? Forgot Your Password? you have another option. Claims Department 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. We must have your written permission before someone can file a grievance for you. The hearing officer will decide whether our decision was right or wrong. It can also be about a provider and/or a service. Member Appeals (Medical, Behavioral Health, and Pharmacy): You will need Adobe Reader to open PDFs on this site. Wellcare uses cookies. We will do this as quickly as possible as but no longer than 72-hours from the decision. BlueCross BlueShield of South Carolina Piedmont Service Center P.O. Q. Only you or your authorizedrepresentative can ask for a State Fair Hearing. 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. Claims submission, correspondence, and contact resources will stay the same for the Medicare line of business. They must inform their vendor of AmeriHealth Caritas . You must ask within 30 calendar days of getting our decision. 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? Here are some guides we created to help you with claims filing. Please be sure to use the correct line of business prior authorization form for prior authorization requests. Keep yourself informed about Coronavirus (COVID-19.) If Statement Range is April 2, 2021 through April 10, 2021, please send to Absolute Total Care. Copyright 2023 Wellcare Health Plans, Inc. PROVIDERS NOTE:Please send Corrected Claims as normal submissions via electronic or paper. Members will receive a 90-day transition of care period if the member is receiving ongoing care and treatment. Wellcare uses cookies. 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. P.O. Pregnant members receiving care from an out of network Obstetrician can continue to see their current Obstetrician until after the baby is born. Members will need to talk to their provider right away if they want to keep seeing him/her. (This includes your PCP or another provider.) Payments mailed to providers are subject to USPS mailing timeframes. Providers will continue to follow WellCares Medicaid policies and procedures for services provided to WellCare Medicaid members for dates of service prior to April 1, 2021. To do this: Contact Absolute Total Care Provider Service at1-866-433-6041if youhave questions. Q. Members will need to talk to their provider right away if they want to keep seeing him/her. Please see list of services that will require authorization during this time. Select Health Claims must be filed within 12 months from the date of service. Where should I submit claims for WellCare Medicaid members? All billing requirements must be adher ed to by the provider in order to ensure timely processing of claims. An authorized representative is someone you select to act on the behalf of a member to assist them through the appeals process. South Carolina DEPARTMENT OF HEALTH AND HUMAN SERVICES Post Office Box 8206 Columbia, South Carolina 29202-8206 www.scdhhs.gov November 24, 2009 ALL . In South Carolina, WellCare and Absolute Total Care are joining to better serve you. Finding a doctor is quick and easy. Box 6000 Greenville, SC 29606. DOS prior to April 1, 2021: Processed by WellCare. You can ask in writing for a State Fair Hearing (hearing, for short). Q. 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. From Date Institutional Statement Dates prior to 4/1/2021 should be filed to WellCare of South Carolina. \{-w{,xI202100$0*bZf ,X AayhP3pYla" e 3G& `eoT#@ *;d 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. If an authorization is needed, you can log in to the Secure Provider Portal at absolutetotalcare.com to submit and confirm authorizations. We are proud to announce that WellCare is now part of the Centene Family. 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. To avoid rejections please split the services into two separate claim submissions. Download the free version of Adobe Reader. Box 8206 Columbia, SC 29202-8206 Or call 1-800-763-9087. Claims for services prior to April 1, 2021 should be filed to WellCare for processing. Attn: Grievance Department It is called a "Notice of Adverse Benefit Determination" or "NABD." 837 Institutional Encounter 5010v Guide All dates of service prior to April 1, 2021 should be filed to WellCare of South Carolina. Please Explore the Site and Get To Know 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. We will also send you a letter with our decision within 72 hours from receiving your appeal. With the completion of this transaction, we have created a premier healthcare enterprise focused on government-sponsored healthcare programs. z4M0(th`1Lf`M18c BIcJ[%4l JU2 _ s In this section, we will explain how you can tell us about these concerns/grievances. The second level review will follow the same process and procedure outlined for the initial review. If you need assistance with your appeal please call Absolute Total Care at 1-866-433-6041 (TTY: 711) and we will assist you in filing your appeal. Box 31224 Absolute Total Care will honor those authorizations. Q. You may file your second level grievance review within 30 days of receiving your grievance decision letter. Tampa, FL 33631-3372. 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. The participating provider agreement with WellCare will remain in-place after 4/1/2021. The Medicare portion of the agreement will continue to function in its entirety as applicable. Tampa, FL 33631-3384. 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 Absolute Total Care, a Centene company, is now the health plan for South Carolina Medicaid members. 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. You can file a grievance by calling or writing to us. You can file the grievance yourself. If you request a hearing, the request must: A State Fair Hearing is a legal proceeding. You can get many of your Coronavirus-related questions answered here. Date of Occurrence/DOSprior toApril 1, 2021: Processed by WellCare. Examples: If Statement Range is March 14, 2021 through April 3, 2021, please send to WellCare. Q. Provider can't require members to appoint them as a condition of getting services. 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. WellCare Medicare members are not affected by this change. Timely Filing Beginning October 1, 2020, the Timely Filing submission requirements specified in each Provider's Meridian Medicare contract will be enforced. A. You will get a letter from us when any of these actions occur. Need an account? 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 . WellCare has partnered with Change Healthcare as our preferred EDI Clearinghouse. WellCare of South Carolina will be known as Absolute Total Care as of April 1, 2021. Select your topic and plan and click "Chat Now!" to chat with a live agent! Our toll-free fax number is 1-877-297-3112. Visit https://msp.scdhhs.gov/appeals/ to: Copyright 2023 Wellcare Health Plans, Inc. https://msp.scdhhs.gov/appeals/site-page/file-appeal, If we deny or limit a service you or your doctor asks us to approve, If we reduce, suspend or stop services youve been getting that we already approved, If we do not pay for the health care services you get, If we fail to give services in the required timeframe, If we fail to give you a decision in the required timeframe on an appeal you already filed, If we dont agree to let you see a doctor who is not in our network and you live in a rural area or in an area with limited doctors, If you dont agree with a decision we made regarding your medicine, We denied your request to dispute a financial liability, The member did not personally receive the notice of action or received the notice late, The member was seriously ill, which prevented a timely appeal, There was a death or serious illness in the members immediate family, An accident caused important records to be destroyed, Documentation was difficult to locate within the time limits; and/or the member had incorrect or incomplete information concerning the appeals process, Change the appeal to the timeframe for a standard decision (30 calendar days), Follow up with a written letter within 2 calendar days, Tell you over the phone and in writing that you may file a grievance about the denial of the fast appeal request, Be in writing and specify the reason for the request, Include your name, address and phone number, Indicate the date of service or the type of service denied, Your authorized representative (if youve chosen one), A hearing officer from Medicaid and Long-Term Care (MLTC), You or your authorized representative with your written consent must file your appeal with us and ask to continue your benefits within 10 calendar days after we mail the Notice of Adverse benefit determination; or, Within 10 calendar days of the intended effective date of the plans proposed action, whichever is later, The appeal or hearing must address the reduction, suspension or stopping of a previously authorized service, The services were ordered by an authorized provider, The period covered by the original authorization cannot have ended. Earliest From Dates on or after 4/1/2021 should be filed to Absolute Total Care. 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. We are proud to announce that WellCare is now part of the Centene Family.
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