As of April 1, 2021, all WellCare of South Carolina Medicaid members will transfer to Absolute Total Care. Will WellCare continue to offer current products or Medicare only? Box 8206 More Information Need help? It will tell you we received your grievance. Q. If you file a grievance or an appeal, we must be fair. The onlineProvider Manual represents the most up-to-date information on Wellcare Prime by Absolute Total Care (Medicare-Medicaid Plan), programs, policies, and procedures. Here are some guides we created to help you with claims filing. Medicaid North Carolina | Healthy Blue of North Carolina Professional and Institutional Fee-For-Service EDI transactions should be submitted to WellCare of South Carolina Medicaid with Payer ID 14163. 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. Explains rules and state, line of business and CMS-specific regulations regarding 837P EDI transactions. 1,flQ*!WLOmsmz\D;I5BI,yA#z!vYQi5'fedREF40 b666q1(UtUJJ.i` (T/@E You or your provider must call or fax us to ask for a fast appeal. Medicaid Claims Payment Policies Provider can't require members to appoint them as a condition of getting services. P.O. 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. An authorized representative is someone you select to act on the behalf of a member to assist them through the appeals process. WellCare of South Carolina will be known as Absolute Total Care as of April 1, 2021. Box 31224 For dates of service prior to April 1, 2021: All paper claim submissions can be mailed to: WellCare Health Plans \{-w{,xI202100$0*bZf ,X AayhP3pYla" e 3G& `eoT#@ *;d However, as of April 1, 2021, all WellCare of South Carolina Medicaid members will become Absolute Total Care members. HealthPlan - redirect.centene.com - Allwell Medicare Timely Filing Limit: Timely Filing Limit is the time frame set by insurance companies and provider has to submit health care claims to respective insurance company within the set time frame for reimbursement of the claims. * Username. We will give you information to help you get the most from your benefits and the services we provide. This manual sets forth the policies and procedures that providers participating in the Absolute Total Carenetwork are required tofollow. If you think you might have been exposed, contact a doctor immediately. How do I join Absolute Total Cares provider network? We expect this process to be seamless for our valued members, and there will be no break in their coverage. Medicaid - Wellcare NC It was a smart move. Timely Filing Limit List in Medica Billing (2020 - Medical Billing RCM 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. Keep yourself informed about Coronavirus (COVID-19.) Please use the Earliest From Date. Claims will be processed according to timely filing provisions in the providers WellCare Participating Provider Agreement. 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. Search for primary care providers, hospitals, pharmacies, and more! Claims will be processed according to timely filing provisions in the providers Absolute Total Care Participating Provider Agreement. A. South Carolina Medicaid & Health Insurance | Absolute Total Care 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 receive an acknowledgement letter within 5 business days, and we will send you a resolution within 90 calendar days. You can get many of your Coronavirus-related questions answered here. Copyright 2023 Wellcare Health Plans, Inc. Clinical Laboratory Improvement Amendments (CLIA). and Human Services Additionally, WellCare will have a migration section on their provider page at publishing FAQs. A. Absolute Total Care will honor those authorizations. WellCare of North Carolina will begin to release medical payments to providers beginning July 6, 2021. North Carolina PHP Billing Guidance for Local W Code. Finding a doctor is quick and easy. 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. 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. The Medicare portion of the agreement will continue to function in its entirety as applicable. Provider Manuals and Forms | Absolute Total Care Q. You can get many of your Coronavirus-related questions answered here. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. You and the person you choose to represent you must sign the AOR statement. In this section, we will explain how you can tell us about these concerns/grievances. Yes, Absolute Total Care and WellCare will continue to offer Medicare products under their current brands and product names, until further notice. Check out the Interoperability Page to learn more. 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 . Register now at https://www.payspanhealth.com or contact PaySpan at providersupport@payspanhealth.com, or 877-331-7154. 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. Symptoms are flu-like, including: Fever Coughing You can ask for a State Fair Hearing after we make our appeal decision. All dates of service prior to April 1, 2021 should be filed to WellCare of South Carolina. endstream endobj startxref 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 the latest COVID-19 news, visit the CDC. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. A. We will send you another letter with our decision within 90 days or sooner. Professional and Institutional Encounter EDI transactions should be submitted to WellCare of South Carolina Medicaid with Payer ID 59354. You will need Adobe Reader to open PDFs on this site. 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. Contact Wellcare Prime Provider Service at1-855-735-4398if youhave questions. 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. Q. Providers interested in joining the Absolute Total Care Provider Network should submit a request to Network Development and Contracting via email at. Explains rules and state, line of business and CMS-specific regulations regarding 837P EDI transactions. 2) Reconsideration or Claim disputes/Appeals. Electronic and Paper Claims Submissions; Institutional Claims/Encounter Guides. Earliest From Dates prior to 4/1/2021 should be filed to WellCare of South Carolina. 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 We expect this process to be seamless for our valued members, and there will be no break in their coverage. Q. Contact Absolute Total Care Provider Service at1-866-433-6041if youhave questions. N .7$* P!70 *I;Rox3 ] LS~. April 1-April 3, 2021, please send to Absolute Total Care. 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. Explains how to receive, load and send 834 EDI files for member information. 2023 Medicare and PDP Compare Plans and Enroll Now. If an authorization is needed, you can log in to the Secure Provider Portal at absolutetotalcare.com to submit and confirm authorizations. To write us, send mail to: You can fax it too. WellCare claims will be processed according to timely filing provisions in the providers WellCare Participating Provider Agreement. A. Members will receive a 90-day transition of care period if the member is receiving ongoing care and treatment. Welcome to Wellcare By Allwell, a Medicare Advantage plan. A. If you dont agree with our appeal decision - and you've completed the appeal steps with our health plan - or, if our appeal decision was not made within the required timeframe (30-calendar days for standard appeals or 72 hours for fast appeals), you may request a State Fair Hearing. 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. Wellcare uses cookies. S< However, there will be no members accessing/assigned to the Medicaid portion of the agreement. 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. 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. 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. Download the free version of Adobe Reader. 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. PDF AmeriHealth Caritas North Carolina Where should I submit claims for WellCare Medicaid members? Pregnant members receiving care from an out-of-network Obstetrician can continue to see their current obstetrician until after the baby is born. 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. 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. 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. Here you will find the tools and resources you need to help manage your submission of claims and receipt of payments. Please Explore the Site and Get To Know Us. 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. Please be sure to use the correct line of business prior authorization form for prior authorization requests. We welcome Brokers who share our commitment to compliance and member satisfaction. Know the facts about Coronavirus (COVID-19) Our call centers, including the nurse advice line, are currently experiencing high volume. Obstetrician care provided by an out-of-network obstetrician will be covered for pregnant members inclusive of postpartum care. 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 You can file a grievance by calling or writing to us. All Paper Claim Submissions can be mailed to: WellCare Health Plans Integration FAQs | Absolute Total Care Initial Claims: 120 Days from the Date of Service. 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. Claims Guides | BlueCross BlueShield 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 healthcare services starting April 1, 2021. Pharmacy services prior to 4/1/2021 must be requested from WellCare South Carolina. 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. Claims for services on or after April 1, 2021 should be filed to Absolute Total Care for processing. 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. WellCare Medicare Advantage Claims must be filed within 180 calendar days from the date of service. Resources B^E{h#XYQv;[ny3Hha1yx4v.sBy jWacQzyL.kHhwtQ~35!Rh#)p+sj31LcC)4*Z:IWIG@WTD- )n,! Providers can begin requesting prior authorization from Absolute Total Care for dates of service on or after April 1, 2021 from Absolute Total Care on March 15, 2021. Welcome to WellCare of South Carolina | Wellcare If Statement Range is March 14, 2021 through April 3, 2021, please send to WellCare. The participating provider agreement with WellCare will remain in-place after April 1, 2021. Need an account? Learn more about how were supporting members and providers. Timely filing limits vary. A. To have someone represent you, you must complete an Appointment of Representative (AOR) form. How are WellCare Medicaid member authorizations being handled after April 1, 2021? This gives members time to establish with a new provider in the network and ensure that they have continuity of care. Claims and billing - Select Health of SC 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. 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. We will notify you orally and in writing. 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 You may file your second level grievance review within 30 days of receiving your grievance decision letter. Home | Wellcare Members can continue to receive services from their current WellCare provider as long as they remain covered under WellCare. Please see list of services that will require authorization during this time. More Information Coronavirus (COVID-19) 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. 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
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