A. For current information, visit the Absolute Total Care website. 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. Contact Us Y0020_WCM_100876E Last Updated On: 10/1/2022 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). 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. With quality healthcare solutions, Ambetter from Absolute Total Care helps residents of South Carolina live better. What will happen to unresolved claims prior to the membership transfer? WellCare of North Carolina partners with providers to develop and deliver high-quality, cost-effective health care solutions. To do so by phone, call Member Services at 1-888-588-9842 (TTY1-877-247-6272). Payments mailed to providers are subject to USPS mailing timeframes. Members will receive a 90-day transition of care period if the member is receiving ongoing care and treatment. It was a smart move. The onlineProvider Manual represents the most up-to-date information on Absolute Total Cares Medicaid Plan, programs, policies, and procedures. 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. We will send you another letter with our decision within 90 days or sooner. If you request a hearing, the request must: A State Fair Hearing is a legal proceeding. If at any time you need help filing one, call us. Professional and Institutional Fee-For-Service EDI transactions should be submitted to WellCare of South Carolina Medicaid with Payer ID 14163. WellCare claims will be processed according to timely filing provisions in the providers WellCare Participating Provider Agreement. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. the timely filing limits due to the provider being unaware of a beneficiary's coverage. The Medicare portion of the agreement will continue to function in its entirety as applicable. 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. Ambetter Timely Filing Limit of : 1) Initial Claims. These materials are for informational purposes only. 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 Attn: Grievance Department We are simplifying Medicare so you can choose and use an affordable local plan that will help you achieve your best possible health. We cannot disenroll you from our plan or treat you differently. 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. hbbd``b`$= $ South Carolina Department of Health and Human Services Division of Appeals and Hearings P.O. Download the free version of Adobe Reader. Contact Absolute Total Care Provider Service at1-866-433-6041if youhave questions. 1071 0 obj
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You may do this in writing or in person. We expect this process to be seamless for our valued members and there will be no break in their coverage. Ambetter from Absolute Total Care - South Carolina. 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. Please use the earliest From Date. Members must have Medicaid to enroll. Finding a doctor is quick and easy. You must file your appeal within 60 calendar days from the date on the NABD. Q. However, there will be no members accessing/assigned to the Medicaid portion of the agreement. 2) Reconsideration or Claim disputes/Appeals. Tampa, FL 33631-3384. 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. 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. 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. Those who attend the hearing include: You can also request to have your hearing over the phone. 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. Register now. Effective January 1, 2015 the South Carolina Department of Health and Human Services (SCDHHS) will implement a Claim Reconsideration Policy. Initial Claims: 120 Days from the Date of Service. 941w*)bF
iLK\c;nF mhk} 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. Yes, Absolute Total Care and WellCare will continue to offer Medicare products under their current brands and product names, until further notice. 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! Explains rules and state, line of business and CMS-specific regulations regarding 837P EDI transactions. 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. State Health Plan State Claims P.O. Will WellCare continue to offer current products or Medicare only? It is 30 days to 1 year and more and depends on . Box 3050 WellCare claims will be processed according to timely filing provisions in the providers WellCare Participating Provider Agreement. Q. We expect this process to be seamless for our valued members and there will be no break in their coverage. The participating provider agreement with WellCare will remain in-place after 4/1/2021. We have licensed clinicians available to speak with you and to connect you to the support you need to feel better. DOS prior to April 1, 2021: Processed by WellCare. 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. You will need Adobe Reader to open PDFs on this site. DOS April 1, 2021 and after: Processed by Absolute Total Care. Here are some guides we created to help you with claims filing. DOSApril 1, 2021 and after: Processed by Absolute Total Care. Q. 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. They must inform their vendor of AmeriHealth Caritas . To earn rewards, members must: Download the Go365 for Humana Healthy Horizons app onto a mobile device from the Apple App Store or Google Play. You may request a State Fair Hearing at this address: South Carolina Department of Health PROVIDERS NOTE:Please send Corrected Claims as normal submissions via electronic or paper. If you file a grievance or an appeal, we must be fair. Q. 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. Box 100605 Columbia, SC 29260. Beginning. Box 6000 Greenville, SC 29606. Q. Here you will find the tools and resources you need to help manage your submission of claims and receipt of payments. You must ask within 30 calendar days of getting our decision. L]4(f4/pn~YTZSp-5/O*F)e~p:a6o{x8r 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. 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 and the person you choose to represent you must sign the AOR statement. BlueCross BlueShield of South Carolina Piedmont Service Center P.O. Your second-level review will be performed by person(s) not involved in the first review. 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. If an authorization is needed, you can log in to the Secure Provider Portal at absolutetotalcare.com to submit and confirm authorizations. Additionally, WellCare will have a migration section on their provider page at
publishing FAQs. Farmington, MO 63640-3821. 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 standard requests, if you call in your appeal, you must follow up with a written, signed one, within thirty calendar days. Contact Wellcare Prime Provider Service at1-855-735-4398if youhave questions. 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. WellCare of South Carolina will be known as Absolute Total Care as of April 1, 2021. Wfu neebybfgnh bgWfulnybfgC South Carolina Medicaid Provider Resource Guide Thank you for being a star member of our provider team. endstream
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Q. 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. 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. We expect this process to be seamless for our valued members, and there will be no break in their coverage. North Carolina PHP Billing Guidance for Local W Code. Providers are encouraged to sign up to receive EFT payments to avoid any payment delays. Need an account? If you are unable to view PDFs, please download Adobe Reader. ?-}++lz;.0U(_I]:3O'~3-~%-JM The member will be encouraged to establish care with a new in network PCP/specialist prior to the end of the transition/continuity of care period to review present treatment plan and coordinate the member's medical care. 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. We will give you information to help you get the most from your benefits and the services we provide. For dates of service on or after April 1, 2021: Absolute Total Care The provider needs to contact Absolute Total Care to arrange continuing care. Providers can help facilitate timely claim payment by having an understanding of our processes and requirements. 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. WellCare understands that having access to the right tools can help you and your staff streamline day-to-day administrative tasks. This person has all beneficiary rights and responsibilities during the appeal process. 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. Kasapulam ti tulong? Refer to your particular provider type program chapter for clarification. PROVIDER REMINDER: It is important that providers check eligibility prior to providing services as members can potentially change plans prior to 4/1/2021 if they are in the annual choice period. Outpatient Prior Authorization Form (PDF) Inpatient Prior Authorization Form (PDF) 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. To avoid rejections please split the services into two separate claim submissions. You can file your appeal by calling or writing to us. WellCare credentialing cycles will be shared with Absolute Total Care in order to reduce duplicative credentialing in the future. Copyright 2023 Wellcare Health Plans, Inc. The onlineProvider Manual represents the most up-to-date information on Wellcare Prime by Absolute Total Care (Medicare-Medicaid Plan), programs, policies, and procedures. 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. A. 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 Medicare Advantage Claims must be filed within 180 calendar days from the date of service. To do so by phone, call Member Services at 1-888-588-9842 (TTY1-877-247-6272). 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. However, as of April 1, 2021, all WellCare of South Carolina Medicaid members will become Absolute Total Care members. You can get many of your Coronavirus-related questions answered here. Ancillary Claims Filing Reminders; ClaimsXten TM: Correct Coding Initiative Reference Guide; Inpatient Non-Reimbursable Charges/Unbundling Policy Additionally, WellCare will have a migration section on their provider page at publishing FAQs. Explains rules and state, line of business and CMS-specific regulations regarding 837P EDI transactions. Please use the From Date Institutional Statement Date. Q. Please use the From Date Institutional Statement Date. Claims will be processed according to timely filing provisions in the providers Absolute Total Care Participating Provider Agreement. If you wish to use a representative, then he or she must complete an Appointment of Representative (AOR) statement. 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. Claims for services on or after April 1, 2021 should be filed to Absolute Total Care for processing. 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. Pharmacy services prior to April 1, 2021 must be requested from WellCare of South Carolina. (This includes your PCP or another provider.) Will my existing WellCare patients be assigned to my Absolute Total Care Panel? You can file the grievance yourself. Wellcare uses cookies. 1,flQ*!WLOmsmz\D;I5BI,yA#z!vYQi5'fedREF40
b666q1(UtUJJ.i` (T/@E 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. Claims submission, correspondence, and contact resources will stay the same for the Medicare line of business. P.O. First Choice can accept claim submissions via paper or electronically (EDI). No, Absolute Total Care will continue to operate under the Absolute Total Care name. More Information Coronavirus (COVID-19) 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. Example of how to properly split claim that span the cutover date of April 1, 2021: Q. Learn more about how were supporting members and providers. All dates of service prior to April 1, 2021 should be filed to WellCare of South Carolina. With the completion of this transaction, we have created a premier healthcare enterprise focused on government-sponsored healthcare programs. This must be done within 120 days from the date of Notice of Appeal Resolution you received from us. For the latest COVID-19 news, visit the CDC. You can also have a video visit with a doctor using your phone or computer. If you think you might have been exposed, contact a doctor immediately. 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. Q. As of April 1, 2021, all WellCare of South Carolina Medicaid members will transfer to Absolute Total Care. We must have your written permission before someone can file a grievance for you. Members can continue to receive services from their current WellCare provider as long as they remain covered under WellCare. The second level review will follow the same process and procedure outlined for the initial review. A. 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). You will receive an acknowledgement letter within 5 business days, and we will send you a resolution within 90 calendar days. Member Sign-In. Tampa, FL 33631-3372. 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. 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. 8h} \x p`03
1z`@+`~70 G ~Ws5Puick79,4 ,O5@?O-Gr'|5Oj:v6/` Q. Absolute Total Care will honor all existing WellCare authorization approvals that include dates of service beyond March 31, 2021. Overview & Resources WellCare of North Carolina partners with providers to develop and deliver high-quality, cost-effective health care solutions. 3) Coordination of Benefits. If an authorization is needed, you can log in to the Secure Provider Portalto submit and confirm authorizations. That's why we provide tools and resources to help. Federal Employee Program (FEP) Federal Employee Program 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. Additionally, WellCare will have a migration section on their provider webpage publishing FAQs. Forgot Your Password? An appeal may be filed within 60 calendar days from the date on the Adverse Benefit Determination Notice. Know the facts about Coronavirus (COVID-19) Our call centers, including the nurse advice line, are currently experiencing high volume. We will review it and send you a decision letter within 30 calendar days from receiving your appeal. Q. With the completion of this transaction, we have created a premier healthcare enterprise focused on government-sponsored healthcare programs. Search for primary care providers, hospitals, pharmacies, and more! Q. You can make three types of grievances. 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. 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. 0
We are proud to announce that WellCare is now part of the Centene Family. UnitedHealthcare Dual Complete Special Needs Plan UnitedHealthcare Dual Complete Special Needs Plans (SNP) offer benefits for people with both Medicare and Medicaid. 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. You can get many of your Coronavirus-related questions answered here. Members can continue to receive services from their current WellCare provider as long as they remain covered under WellCare. A. A. WellCare credentialing cycles will be shared with Absolute Total Care in order to reduce duplicative credentialing in the future. 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.
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