A provider can act for a member in hearings with the member's written permission in advance. If you are unable to view PDFs, please download Adobe Reader. 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. Claims will be processed according to timely filing provisions in the providers WellCare Participating Provider Agreement. You must file your appeal within 60 calendar days from the date on the NABD. 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. ?-}++lz;.0U(_I]:3O'~3-~%-JM 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. Federal Employee Program (FEP) Federal Employee Program P.O. 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. 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. The annual flu vaccine helps prevent the flu.Protect yourself and those around you. 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. Absolute Total Care will honor all existing WellCare authorization approvals that include dates of service beyond March 31, 2021. For standard requests, if you call in your appeal, you must follow up with a written, signed one, within thirty calendar days. What will happen to unresolved claims prior to the membership transfer? Pregnant members receiving care from an out-of-network Obstetrician can continue to see their current obstetrician until after the baby is born. You may file your second level grievance review within 30 days of receiving your grievance decision letter. 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. Members can continue to receive services from their current WellCare provider as long as they remain covered under WellCare. Member Sign-In. 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. Claims for services prior to April 1, 2021 should be filed to WellCare for processing. 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 South Carolina | Wellcare SOUTH CAROLINA Healthcare done well. 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 . Contact Wellcare Prime Provider Service at1-855-735-4398if youhave questions. You will have a limited time to submit additional information for a fast appeal. The benefit can be used to get more than 150 items - including vitamins, pain relievers, cold and allergy medicines, baby wipes, and diapers - at no cost . P.O. L]4(f4/pn~YTZSp-5/O*F)e~p:a6o{x8r As a member you may request a 14 day extension of your grievance, you may do so by calling Member Services at 1-888-588-9842 (TTY 1-877-247-6272) or You may send your request for extension in writing to: WellCare Health Plans S< Only you or your authorizedrepresentative can ask for a State Fair Hearing. The provider needs to contact Absolute Total Care to arrange continuing care. It will tell you we received your grievance. You now have access to a secure, quick way to electronically settle claims. Absolute Total Care will continue to offer Marketplace products under the Ambetter brand. Box 3050 N .7$* P!70 *I;Rox3 ] LS~. and Human Services This manual sets forth the policies and procedures that providers participating in the Wellcare Prime network are required to follow. Download the free version of Adobe Reader. Pharmacy services prior to April 1, 2021 must be requested from WellCare of South Carolina. We are simplifying Medicare so you can choose and use an affordable local plan that will help you achieve your best possible health. More Information Need help? All dates of service on or after 4/1/2021 should be filed to Absolute Total Care. This must be done within 120 days from the date of Notice of Appeal Resolution you received from us. You can do this at any time during your appeal. For general questions about claims submissions, call Provider Claims Services at 1-800-575-0418. Additionally, WellCare will have a migration section on their provider webpage publishing FAQs. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. Box 8206 Columbia, SC 29202-8206 Or call 1-800-763-9087. 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. You will get a letter from us when any of these actions occur. BlueCross BlueShield of South Carolina Piedmont Service Center P.O. Ancillary Claims Filing Reminders; ClaimsXten TM: Correct Coding Initiative Reference Guide; Inpatient Non-Reimbursable Charges/Unbundling Policy Q. Hearings are used when you were denied a service or only part of the service was approved. Download the free version of Adobe Reader. 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 By continuing to use our site, you agree to our Privacy Policy and Terms of Use. WellCare Medicare members are not affected by this change. Finding a doctor is quick and easy. Always verify timely filing requirements with the third party payor. We are proud to announce that WellCare is now part of the Centene Family. 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. WellCare of South Carolina will be known as Absolute Total Care as of April 1, 2021. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. We understand that maintaining a healthy community starts with providing care to those who need it most. 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. There is a lot of insurance that follows different time frames for claim submission. 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. Box 31384 WellCare has partnered with Change Healthcare as our preferred EDI Clearinghouse. For dates of service on or after April 1, 2021: Absolute Total Care We are glad you joined our family! These materials are for informational purposes only. 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. This manual sets forth the policies and procedures that providers participating in the Wellcare Prime network are required tofollow. All billing requirements must be adher ed to by the provider in order to ensure timely processing of claims. Explains rules and state, line of business and CMS-specific regulations regarding 837I EDI transactions. You can ask for a State Fair Hearing after we make our appeal decision. If an authorization is needed, you can log in to the Secure Provider Portal at absolutetotalcare.com to submit and confirm authorizations. 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. March 14-March 31, 2021, please send to WellCare. Example of how to properly split claim that span the cutover date of April 1, 2021: Yes, Absolute Total Care and WellCare will continue to offer Medicare products under their current brands and product names, until further notice. However, there will be no members accessing/assigned to the Medicaid portion of the agreement. You will need Adobe Reader to open PDFs on this site. WellCare Medicaid members migrating to Absolute Total Care will be assigned to their assigned WellCare Primary Care Physician (PCP) as if the PCP is in network with Absolute Total Care. B^E{h#XYQv;[ny3Hha1yx4v.sBy jWacQzyL.kHhwtQ~35!Rh#)p+sj31LcC)4*Z:IWIG@WTD- )n,! Q. Professional and Institutional Fee-For-Service EDI transactions should be submitted to WellCare of South Carolina Medicaid with Payer ID 14163. Q. 1071 0 obj <>/Filter/FlateDecode/ID[<87133B316ADA4BDD8B85BA48A489D34F>]/Index[1044 53]/Info 1043 0 R/Length 117/Prev 692690/Root 1045 0 R/Size 1097/Type/XRef/W[1 2 1]>>stream Please be sure to use the correct line of business prior authorization form for prior authorization requests. 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. A. You or your provider must call or fax us to ask for a fast appeal. In South Carolina, WellCare and Absolute Total Care are joining to better serve you. Our call centers, including the nurse advice line, are currently experiencing high volume. WellCare and Absolute Total Care Medicare plans will continue to operate under current brands, product names and provider contracts, until further notice. 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. Timely Filing Beginning October 1, 2020, the Timely Filing submission requirements specified in each Provider's Meridian Medicare contract will be enforced. These SNP plans provide benefits beyond Original Medicare, and may include transportation to medical appointments and vision exams. Call us to get this form. How do I bill a professional submission with services spanning before and after 04/01/2021? 2023 Medicare and PDP Compare Plans and Enroll Now. 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. Exceptions to the one-year time limit: a) Medicare Cost Sharing Claims . Coronavirus Disease 2019 (COVID-19) causes respiratory illness in people and can spread from person to person. WellCare of South Carolinawants to ensure that claims are handled as efficiently as possible. A hearing officer from the State will decide if we made the right decision. hbbd``b`$= $ 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. 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. Box 100605 Columbia, SC 29260. 8h} \x p`03 1z`@+`~70 G ~Ws5Puick79,4 ,O5@?O-Gr'|5Oj:v6/` Explains how to receive, load and send 834 EDI files for member information. 1044 0 obj <> endobj Please use the Earliest From Date. They must inform their vendor of AmeriHealth Caritas . Our fax number is 1-866-201-0657. Examples: If Statement Range is March 14, 2021 through April 3, 2021, please send to WellCare. Copyright 2023 Wellcare Health Plans, Inc. 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. Copyright 2023 Wellcare Health Plans, Inc. 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. Division of Appeals and Hearings Will WellCare continue to offer current products or Medicare only? An appeal is a request you can make when you do not agree with a decision we made about your care. This person has all beneficiary rights and responsibilities during the appeal process. If Statement Range is April 2, 2021 through April 10, 2021, please send to Absolute Total Care. We expect this process to be seamless for our valued members, and there will be no break in their coverage. Members will receive a 90-day transition of care period if the member is receiving ongoing care and treatment. Box 8206 Explains rules and state, line of business and CMS-specific regulations regarding 837P EDI transactions. Here are some guides we created to help you with claims filing. WellCare of South Carolina will be known as Absolute Total Care as of April 1, 2021. 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. Tampa, FL 33631-3384. \{-w{,xI202100$0*bZf ,X AayhP3pYla" e 3G& `eoT#@ *;d You may request a State Fair Hearing at this address: South Carolina Department of Health Learn how you can help keep yourself and others healthy. WellCare of South Carolina will be known as Absolute Total Care as of April 1, 2021. Claims will be processed according to timely filing provisions in the providers Absolute Total Care Participating Provider Agreement. The onlineProvider Manual represents the most up-to-date information on Wellcare Prime by Absolute Total Care (Medicare-Medicaid Plan), programs, policies, and procedures. Payments mailed to providers are subject to USPS mailing timeframes. A. Claims for services prior to April 1, 2021 should be filed to WellCare for processing. 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. WellCare Medicaid members migrating to Absolute Total Care will be assigned to their assigned WellCare Primary Care Physician (PCP) as if the PCP is in network with Absolute Total Care. Instructions on how to submit a corrected or voided claim. The second level review will follow the same process and procedure outlined for the initial review. 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? The hearing officer will decide whether our decision was right or wrong. Absolute Total Care With the completion of this transaction, we have created a premier healthcare enterprise focused on government-sponsored healthcare programs. With quality healthcare solutions, Ambetter from Absolute Total Care helps residents of South Carolina live better. Wellcare uses cookies. 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. WellCare is the health care plan that puts you in control. South Carolina Department of Health and Human Services Division of Appeals and Hearings P.O. WellCare understands that having access to the right tools can help you and your staff streamline day-to-day administrative tasks. How do I determine if an institutional inpatient bill type submission overlapping 4/1/2021 should be filed to WellCare or Absolute Total Care? Keep yourself informed about Coronavirus (COVID-19.) We cannot disenroll you from our plan or treat you differently. Contact Wellcare Prime Provider Service at 1-855-735-4398 if you have questions. You and the person you choose to represent you must sign the AOR statement.
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