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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. 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. N .7$* P!70 *I;Rox3 ] LS~. Reimbursement Policies Members will need to talk to their provider right away if they want to keep seeing him/her. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. Q. A. DOS prior toApril 1, 2021: Processed by WellCare. 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. We are simplifying Medicare so you can choose and use an affordable local plan that will help you achieve your best possible health. Q. 1096 0 obj <>stream Farmington, MO 63640-3821. 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. It will tell you we received your grievance. If you file a grievance or an appeal, we must be fair. You may file your second level grievance review within 30 days of receiving your grievance decision letter. Contact Us Y0020_WCM_100876E Last Updated On: 10/1/2022 WellCare of South Carolina will be known as Absolute Total Care as of April 1, 2021. Q. DOSApril 1, 2021 and after: Processed by Absolute Total Care. Claims will be processed according to timely filing provisions in the providers WellCare Participating Provider Agreement. Select your topic and plan and click "Chat Now!" to chat with a live agent! Q. Initial Claims: 120 Days from the Date of Service. We will give you information to help you get the most from your benefits and the services we provide. 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. 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. 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. WellCare of North Carolina will begin to release medical payments to providers beginning July 6, 2021. 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. 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? Wellcare wants to ensure that claims are handled as efficiently as possible. Providers interested in joining the Absolute Total Care vision network for routine vision services can contact Envolve Vision at 1-800-531-2818. To do so by phone, call Member Services at 1-888-588-9842 (TTY1-877-247-6272). 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. 941w*)bF iLK\c;nF mhk} P.O. WellCare Health Plans, Inc. (NYSE: WCG) is now offering a $120 credit per family, per year towards over-the-counter (OTC) items as part of its Medicaid program benefits in South Carolina. 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 use the earliest From Date. A. Those who attend the hearing include: You can also request to have your hearing over the phone. Copyright 2023 Wellcare Health Plans, Inc. 2) Reconsideration or Claim disputes/Appeals. (This includes your PCP or another provider.) Will Absolute Total Care change its name to WellCare? We are proud to announce that WellCare is now part of the Centene Family. Forgot Your Password? Please use the From Date Institutional Statement Date. 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. What will happen to unresolved claims prior to the membership transfer? We are committed to improving the quality of life of our millions of members, who often include some of our nations most vulnerable populations. We expect this process to be seamless for our valued members and there will be no break in their coverage. Outpatient Prior Authorization Form (PDF) Inpatient Prior Authorization Form (PDF) 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. Q. Member Sign-In. Molina Healthcare of Michigan, 100 W. Big Beaver Road, Suite 600 Attn: Claims, Troy, MI 48084-5209 Or Fax to: (248) 925-1768. The provider needs to contact Absolute Total Care to arrange continuing care. Absolute Total Care will honor all existing WellCare authorization approvals that include dates of service beyond March 31, 2021. Learn more about how were supporting members and providers. Pharmacy services prior to 4/1/2021 must be requested from WellCare South Carolina. We have licensed clinicians available to speak with you and to connect you to the support you need to feel better. 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. Wfu neebybfgnh bgWfulnybfgC South Carolina Medicaid Provider Resource Guide Thank you for being a star member of our provider team. How do I join Absolute Total Cares provider network? 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 Wellcare uses cookies. 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 State Health Plan State Claims P.O. 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. Please use the From Date Institutional Statement Date. 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. 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. Our fax number is 1-866-201-0657. This person has all beneficiary rights and responsibilities during the appeal process. 3) Coordination of Benefits. Earliest From Dates on or after April 1, 2021 should be filed to Absolute Total Care. Providers can help facilitate timely claim payment by having an understanding of our processes and requirements. 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. For additional information, questions or concerns, please contact your local Provider Network Management Representative. The second level review will follow the same process and procedure outlined for the initial review. 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 Shop or Enroll in a Plan Frequently Asked Questions Find a Doctor Download Digital ID Card Welcome Allwell Members! 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. 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. Box 31224 Members can continue to receive services from their current WellCare provider as long as they remain covered under 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. No, Absolute Total Care will continue to operate under the Absolute Total Care name. Q. We understand that maintaining a healthy community starts with providing care to those who need it most. Division of Appeals and Hearings This manual sets forth the policies and procedures that providers participating in the Wellcare Prime network are required to follow. 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. Written notice is not needed if your expedited appeal request is filed verbally. Timely filing limits vary. Box 31224 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. There is a lot of insurance that follows different time frames for claim submission. Our call centers, including the nurse advice line, are currently experiencing high volume. They must inform their vendor of AmeriHealth Caritas . To have someone represent you, you must complete an Appointment of Representative (AOR) form. A. Additionally, WellCare will have a migration section on their provider page at publishing FAQs. Claims will be processed according to timely filing provisions in the providers Absolute Total Care Participating Provider Agreement. A grievance is when you tell us about a concern you have with our plan. In South Carolina, WellCare and Absolute Total Care are joining to better serve you. South Carolina | Wellcare SOUTH CAROLINA Healthcare done well. Get an annual flu shot today. 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. WellCare and Absolute Total Care Medicare plans will continue to operate under current brands, product names and provider contracts, until further notice. Claims will be processed according to timely filing provisions in the providers Absolute Total Care Participating Provider Agreement. Instructions on how to submit a corrected or voided claim. Will WellCare continue to offer current products or Medicare only? 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. We would like to help your billing department get your EDI (claims and real time) transactions processed as efficiently as possible. Explains how to receive, load and send 834 EDI files for member information. If you think you might have been exposed, contact a doctor immediately. A. WellCare credentialing cycles will be shared with Absolute Total Care in order to reduce duplicative credentialing in the future. The annual flu vaccine helps prevent the flu.Protect yourself and those around you. P.O. Contact Wellcare Prime Provider Service at 1-855-735-4398 if you have questions. 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. 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. Q. Kasapulam ti tulong? Instructions on how to submit a corrected or voided claim. A. If you wish to use a representative, then he or she must complete an Appointment of Representative (AOR) statement. 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. 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. Q. Claims for services prior to April 1, 2021 should be filed to WellCare for processing. You can do this at any time during your appeal. You, your friend, a relative, legal counsel or other spokesperson who has your written consent may ask for a State Fair Hearing. 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. All Paper Claim Submissions can be mailed to: WellCare Health Plans You can file a grievance by calling or writing to us. Copyright 2023 Wellcare Health Plans, Inc. Clinical Laboratory Improvement Amendments (CLIA). 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 837I EDI transactions. 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. We may apply a 14 day extension to your grievance resolution. 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? To avoid rejections please split the services into two separate claim submissions. Please be sure to use the correct line of business prior authorization form for prior authorization requests. You must file your appeal within 60 calendar days from the date on the NABD. WellCare offers participating providers EFT and ERA services at no charge through PaySpan Health. They are called: State law allows you to make a grievance if you have any problems with us. If an authorization is needed, you can log in to the Secure Provider Portalto submit and confirm authorizations. Q. To write us, send mail to: You can fax it too. Will Absolute Total Care continue to offer Medicare and Marketplace products? A. 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 . It can also be about a provider and/or a service. 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. The Medicare portion of the agreement will continue to function in its entirety as applicable. The materials located on our website are for dates of service prior to April 1, 2021. If you are unable to view PDFs, please download Adobe Reader. you have another option. 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. Register now at https://www.payspanhealth.com or contact PaySpan at [email protected], or 877-331-7154. Effective January 1, 2015 the South Carolina Department of Health and Human Services (SCDHHS) will implement a Claim Reconsideration Policy. Check out the Interoperability Page to learn more. Want to receive your payments faster to improve cash flow? Tampa, FL 33631-3384. Select Health Claims must be filed within 12 months from the date of service. Q. You can file the grievance yourself. As of April 1, 2021, all WellCare of South Carolina Medicaid members will transfer to Absolute Total Care. 1,flQ*!WLOmsmz\D;I5BI,yA#z!vYQi5'fedREF40 b666q1(UtUJJ.i` (T/@E A. We will notify you orally and in writing. No, Absolute Total Care will continue to operate under the Absolute Total Care name. 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. Know the facts about Coronavirus (COVID-19) Our call centers, including the nurse advice line, are currently experiencing high volume. An appeal may be filed within 60 calendar days from the date on the Adverse Benefit Determination Notice. First Choice can accept claim submissions via paper or electronically (EDI). South Carolina Department of Health and Human Services Division of Appeals and Hearings P.O. Q. To continue care with their current provider after the 90-day Transition of Care, the provider must agree to work with Absolute Total Care on the member's care and accept Absolute Total Care's payment rates. April 1-April 3, 2021, please send to Absolute Total Care. Additionally, WellCare will have a migration section on their provider webpage publishing FAQs. Q. the timely filing limits due to the provider being unaware of a beneficiary's coverage. Provider can't require members to appoint them as a condition of getting services. 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. If Statement Range is April 2, 2021 through April 10, 2021, please send to Absolute Total Care. At the hearing, well explain why we made our decision. Providers are encouraged to sign up to receive EFT payments to avoid any payment delays. Symptoms are flu-like, including: Fever Coughing It will let you know we received your appeal. * Password. How do I determine if an institutional inpatient bill type submission overlapping 4/1/2021 should be filed to WellCare or Absolute Total Care? Wellcare uses cookies. Reconsideration or Claim Disputes/Appeals: As of April 1, 2021, all WellCare of South Carolina Medicaid members will become Absolute Total Care members. A. S< WellCare Medicare members are not affected by this change. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. Yes, Absolute Total Care and WellCare will continue to offer Medicare products under their current brands and product names, until further notice. Attn: Grievance Department However, as of April 1, 2021, all WellCare of South Carolina Medicaid members will become Absolute Total Care members. You will need Adobe Reader to open PDFs on this site. If Statement Range is April 2, 2021 through April 10, 2021, please send to Absolute Total Care. 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. Call us to get this form. You can file your appeal by calling or writing to us. 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. Wellcare uses cookies. P.O. Register now at https://www.payspanhealth.comor contact PaySpan at [email protected], or 877-331-7154. You can ask for a State Fair Hearing after we make our appeal decision. WellCare has partnered with Change Healthcare as our preferred EDI Clearinghouse. 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. Contact Wellcare Prime Provider Service at1-855-735-4398if youhave questions. Exceptions to the one-year time limit: a) Medicare Cost Sharing Claims . 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. Overview & Resources WellCare of North Carolina partners with providers to develop and deliver high-quality, cost-effective health care solutions. 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. 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. The provider needs to contact Absolute Total Care to arrange continuing care. Ambetter Timely Filing Limit of : 1) Initial Claims. 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. 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 If at any time you need help filing one, call us. A. Earliest From Dates prior to April 1, 2021 should be filed to WellCare of South Carolina. People of all ages can be infected. Timely filing is when you file a claim within a payer-determined time limit. You and the person you choose to represent you must sign the AOR form. Member Appeals (Medical, Behavioral Health, and Pharmacy): You will need Adobe Reader to open PDFs on this site. If you request a hearing, the request must: A State Fair Hearing is a legal proceeding. All dates of service prior to April 1, 2021 should be filed to WellCare of South Carolina. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. Download the free version of Adobe Reader. 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. If you need claim filing assistance, please contact your provider advocate. To continue care with their current provider after the 90-day transition of care, the provider must agree to work with Absolute Total Care on the member's care and accept Absolute Total Care's payment rates. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. Federal Employee Program (FEP) Federal Employee Program P.O. 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. 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.