State Health Plan State Claims P.O. Claims Submission, Correspondence and Contact Resources will stay the same for the Medicare line of business. Claims will be processed according to timely filing provisions in the providers WellCare Participating Provider Agreement. No, Absolute Total Care will continue to operate under the Absolute Total Care name. 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. Select your topic and plan and click "Chat Now!" to chat with a live agent! Will WellCare continue to offer current products or Medicare only? The Medicare portion of the agreement will continue to function in its entirety as applicable. Box 600601 Columbia, SC 29260. However, there will be no members accessing/assigned to the Medicaid portion of the agreement. DOS prior to April 1, 2021: Processed by WellCare. We will review it and send you a decision letter within 30 calendar days from receiving your appeal. As of April 1, 2021 Absolute Total Care, a Centene company, is now the health plan for South Carolina Medicaid members. Additionally, WellCare will have a migration section on their provider page at publishing FAQs. A. Will Absolute Total Care continue to offer Medicare and Marketplace products? Ancillary Claims Filing Reminders; ClaimsXten TM: Correct Coding Initiative Reference Guide; Inpatient Non-Reimbursable Charges/Unbundling Policy Wellcare uses cookies. For general questions about claims submissions, call Provider Claims Services at 1-800-575-0418. Our health insurance programs are committed to transforming the health of the community one individual at a time. Overview & Resources WellCare of North Carolina partners with providers to develop and deliver high-quality, cost-effective health care solutions. They are called: State law allows you to make a grievance if you have any problems with us. To ask for hearing, call 1-800-763-9087 or write to: You also can make a request online using SCDHHS form at https://msp.scdhhs.gov/appeals/site-page/file-appeal. We are glad you joined our family! Absolute Total Care will continue to offer Marketplace products under the Ambetter brand. 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. 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. Refer to your particular provider type program chapter for clarification. WellCare has partnered with Change Healthcare as our preferred EDI Clearinghouse. From Date Institutional Statement Dates on or after April 1, 2021 should be filed to Absolute Total Care. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. Copyright 2023 Wellcare Health Plans, Inc. Forgot Your Password? WellCare of North Carolina Medicaid providers are not required to obtain an authorization for professional services for the 90-day post-go live period from July 1, 2021 through September 28, 2021. 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? Members will need to talk to their provider right away if they want to keep seeing him/her. WellCare understands that having access to the right tools can help you and your staff streamline day-to-day administrative tasks. Explains rules and state, line of business and CMS-specific regulations regarding 837P EDI transactions. 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. Farmington, MO 63640-3821. Providers are encouraged to sign up to receive EFT payments to avoid any payment delays. How do I bill a professional submission with services spanning before and after 04/01/2021? P.O. 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 Claims Department You can make three types of grievances. The Medicare portion of the agreement will continue to function in its entirety as applicable. We cannot disenroll you from our plan or treat you differently. This person has all beneficiary rights and responsibilities during the appeal process. DOS prior toApril 1, 2021: Processed by WellCare. 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. You may do this in writing or in person. Date of Occurrence/DOSprior toApril 1, 2021: Processed by WellCare. Contact Us Y0020_WCM_100876E Last Updated On: 10/1/2022 Members can continue to receive services from their current WellCare provider as long as they remain covered under WellCare. Timely filing limits vary. Payments mailed to providers are subject to USPS mailing timeframes. 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. These materials are for informational purposes only. Select Health Claims must be filed within 12 months from the date of service. Guides Filing Claims with WellCare. 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. How are WellCare Medicaid member authorizations being handled after April 1, 2021? April 1-April 3, 2021, please send to Absolute Total Care. 0 Search for primary care providers, hospitals, pharmacies, and more! To do this: 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. Reimbursement Policies Q. Download the free version of Adobe Reader. To avoid rejections please split the services into two separate claim submissions. You can get many of your Coronavirus-related questions answered here. The provider needs to contact Absolute Total Care to arrange continuing care. Please Explore the Site and Get To Know Us. 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. Molina Healthcare of Michigan, 100 W. Big Beaver Road, Suite 600 Attn: Claims, Troy, MI 48084-5209 Or Fax to: (248) 925-1768. You or your authorized representative will tell the hearing officer why you think we made the wrong decision. P.O. With the completion of this transaction, we have created a premier healthcare enterprise focused on government-sponsored healthcare programs. hbbd``b`$= $ Members must have Medicaid to enroll. Please use WellCare Payor ID 14163. Q. With the completion of this transaction, we have created a premier healthcare enterprise focused on government-sponsored healthcare programs. Awagandakami A. #~0 I 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. The way your providers or others act or treat you. 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 Obstetrician care provided by an out-of-network obstetrician will be covered for pregnant members inclusive of postpartum care. Q: What is Absolute Total Cares Transition/Continuity of Care Policy? Please use the From Date Institutional Statement Date. Wellcare uses cookies. Earliest From Dates prior to April 1, 2021 should be filed to WellCare of South Carolina. Welcome to Wellcare By Allwell, a Medicare Advantage plan. Register now at https://www.payspanhealth.com or contact PaySpan at providersupport@payspanhealth.com, or 877-331-7154. Pharmacy services prior to 4/1/2021 must be requested from WellCare South Carolina. As of April 1, 2021, all WellCare of South Carolina Medicaid members will become Absolute Total Care members. All dates of service on or after April 1, 2021 should be filed to Absolute Total Care. 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 Earliest From Dates prior to 4/1/2021 should be filed to WellCare of South Carolina. No, Absolute Total Care will continue to operate under the Absolute Total Care name. This manual sets forth the policies and procedures that providers participating in the Absolute Total Carenetwork are required tofollow. pst/!+ Y^Ynwb7tw,eI^ WellCare Medicare Advantage Claims must be filed within 180 calendar days from the date of service. Explains rules and state, line of business and CMS-specific regulations regarding 837P EDI transactions. We want to ensure that claims are handled as efficiently as possible. An appeal is a request you can make when you do not agree with a decision we made about your care. These SNP plans provide benefits beyond Original Medicare, and may include transportation to medical appointments and vision exams. We will continue covering your medical services during your appeal request and State Fair Hearing if all of the following are meet. Absolute Total Care will honor those authorizations. Please use the Earliest From Date. 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. Send your written appeal to: We must have your written consent before someone can file an appeal for you. Explains rules and state, line of business and CMS-specific regulations regarding 837I EDI transactions. You can file an appeal if you do not agree with 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? How do I determine if a professional or an outpatient bill type institutional submission should be filed to WellCare or Absolute Total Care? 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. Additionally, WellCare will have a migration section on their provider webpage publishing FAQs. 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. Q. A. WellCare claims will be processed according to timely filing provisions in the providers WellCare Participating Provider Agreement. 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. North Carolina PHP Billing Guidance for Local W Code. WellCare of South Carolina will be known as Absolute Total Care as of April 1, 2021. However, as of April 1, 2021, all WellCare of South Carolina Medicaid members will become Absolute Total Care members. 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. Box 6000 Greenville, SC 29606. We will notify you orally and in writing. If Statement Range is April 2, 2021 through April 10, 2021, please send to Absolute Total Care. If you need claim filing assistance, please contact your provider advocate. Our call centers, including the nurse advice line, are currently experiencing high volume. 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. Tampa, FL 33631-3372. Explains rules and state, line of business and CMS-specific regulations regarding 837P EDI transactions. 2023 Medicare and PDP Compare Plans and Enroll Now Notice of Non-Discrimination We comply with applicable Federal civil rights laws and do not discriminate on the basis of race, color, national origin, age, sex, or disability. Member Sign-In. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. Your second-level review will be performed by person(s) not involved in the first review. Q. Learn how you can help keep yourself and others healthy. 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. If you request a hearing, the request must: A State Fair Hearing is a legal proceeding. 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. You can get many of your Coronavirus-related questions answered here. 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). 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. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. Earliest From Dates on or after 4/1/2021 should be filed to Absolute Total Care. From Date Institutional Statement Dates prior to April 1, 2021 should be filed to WellCare of South Carolina. 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. Learn more about how were supporting members and providers. A. 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. Members will receive a 90-day transition of care period if the member is receiving ongoing care and treatment. WellCare Medicare members are not affected by this change. 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. The timely filing limit is the time duration from service rendered to patients and submitting claims to the insurance companies. Copyright 2023 Wellcare Health Plans, Inc. We're here for you. 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. 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. (This includes your PCP or another provider.) A. Claims for services prior to April 1, 2021 should be filed to WellCare for processing. Claims for services on or after April 1, 2021 should be filed to Absolute Total Care for processing. Absolute Total Care will honor those authorizations. 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. This must be done within 120 days from the date of Notice of Appeal Resolution you received from us. 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. you have another option. Box 3050 The provider needs to contact Absolute Total Care to arrange continuing care. All dates of service prior to April 1, 2021 should be filed to WellCare of South Carolina. It can also be about a provider and/or a service. March 14-March 31, 2021, please send to WellCare. We will send you another letter with our decision within 90 days or sooner. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. Absolute Total Care will honor all existing WellCare authorization approvals that include dates of service beyond March 31, 2021. Providers are encouraged to visit the Provider Resources webpagefor manuals, forms, and resources related to claims submission, eligibility, prior authorization, and more. Electronic and Paper Claims Submissions; Institutional Claims/Encounter Guides. You will receive an acknowledgement letter within 5 business days, and we will send you a resolution within 90 calendar days. Tampa, FL 33631-3384. Providers can help facilitate timely claim payment by having an understanding of our processes and requirements. Q. Outpatient Prior Authorization Form (PDF) Inpatient Prior Authorization Form (PDF) 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. z4M0(th`1Lf`M18c BIcJ[%4l JU2 _ s 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. Claim Filing Manual - First Choice by Select Health of South Carolina An appeal may be filed within 60 calendar days from the date on the Adverse Benefit Determination Notice. 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. A. Professional and Institutional Encounter EDI transactions should be submitted to WellCare of South Carolina Medicaid with Payer ID 59354. Box 31224 We welcome Brokers who share our commitment to compliance and member satisfaction. Absolute Total Care From Date Institutional Statement Dates on or after 4/1/2021 should be filed to Absolute Total Care. WellCare Medicare members are not affected by this change. Written notice is not needed if your expedited appeal request is filed verbally. You can file the grievance yourself. To have someone represent you, you must complete an Appointment of Representative (AOR) form. 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. 1044 0 obj <> endobj It is 30 days to 1 year and more and depends on . The Claim Reconsideration process is an informal claim review, and is not a substitute for an appeal of a final agency decision. Explains how to receive, load and send 834 EDI files for member information. We have licensed clinicians available to speak with you and to connect you to the support you need to feel better. BlueCross BlueShield of South Carolina Piedmont Service Center P.O. They must inform their vendor of AmeriHealth Caritas . We process check runs daily, with the exception of Sundays, National Holidays, and the last day of the month. We will call you with our decision if we decide you need a fast appeal. 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).

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