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. Farmington, MO 63640-3821. the timely filing limits due to the provider being unaware of a beneficiary's coverage. 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. 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 manual sets forth the policies and procedures that providers participating in the Absolute Total Carenetwork are required tofollow. The provider needs to contact Absolute Total Care to arrange continuing care. More Information Need help? 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. It was a smart move. B^E{h#XYQv;[ny3Hha1yx4v.sBy jWacQzyL.kHhwtQ~35!Rh#)p+sj31LcC)4*Z:IWIG@WTD- )n,! Attn: Grievance Department 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? Need an account? A. With the completion of this transaction, we have created a premier healthcare enterprise focused on government-sponsored healthcare programs. We will review it and send you a decision letter within 30 calendar days from receiving your appeal. 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. Please be sure to use the correct line of business prior authorization form for prior authorization requests. 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. ?-}++lz;.0U(_I]:3O'~3-~%-JM Explains rules and state, line of business and CMS-specific regulations regarding 837I EDI transactions. As of April 1, 2021, all WellCare of South Carolina Medicaid members will transfer to Absolute Total Care. APPEALS, GRIEVANCES AND PROVIDER DISPUTES. From Date Institutional Statement Dates prior to 4/1/2021 should be filed to WellCare of South Carolina. 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 Welcome to WellCare of South Carolina | Wellcare Timely Filing Limits for all Insurances updated (2023) By continuing to use our site, you agree to our Privacy Policy and Terms of Use. 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. They are called: State law allows you to make a grievance if you have any problems with us. DOSApril 1, 2021 and after: Processed by Absolute Total Care. Division of Appeals and Hearings Always verify timely filing requirements with the third party payor. South Carolina | Medicaid The Medicare portion of the agreement will continue to function in its entirety as applicable. Claims Department WellCare of North Carolina partners with providers to develop and deliver high-quality, cost-effective health care solutions. Kasapulam ti tulong? Box 600601 Columbia, SC 29260. 8h} \x p`03 1z`@+`~70 G ~Ws5Puick79,4 ,O5@?O-Gr'|5Oj:v6/` The timely filing limit is the time duration from service rendered to patients and submitting claims to the insurance companies. Member Sign-In. Copyright 2023 Wellcare Health Plans, Inc. Clinical Laboratory Improvement Amendments (CLIA). Absolute Total Care will honor those authorizations. We will send you another letter with our decision within 90 days or sooner. 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. 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). Members must have Medicaid to enroll. Explains rules and state, line of business and CMS-specific regulations regarding 837I EDI transactions. We must have your written permission before someone can file a grievance for you. For standard requests, if you call in your appeal, you must follow up with a written, signed one, within thirty calendar days. Earliest From Dates prior to 4/1/2021 should be filed to WellCare of South Carolina. You can get many of your Coronavirus-related questions answered here. Providers interested in joining the Absolute Total Care provider network should submit a request to the Network Development and Contracting Department via email at atc_contracting@centene.com. Members can continue to receive services from their current WellCare provider as long as they remain covered under WellCare. The Claim Reconsideration process is an informal claim review, and is not a substitute for an appeal of a final agency decision. Guides Filing Claims with WellCare. For dates of service on or after April 1, 2021: Absolute Total Care Providers are encouraged to sign up to receive EFT payments to avoid any payment delays. You can file your appeal by calling or writing to us. N .7$* P!70 *I;Rox3 ] LS~. 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. Only you or your authorizedrepresentative can ask for a State Fair Hearing. Appeals and Grievances | Wellcare 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. 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. 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 make sure you ask your members for a copy of their Absolute Total Care and Healthy Connections Choices Medicaid ID cards before each visit. Payments mailed to providers are subject to USPS mailing timeframes. A. Wfu neebybfgnh bgWfulnybfgC South Carolina Medicaid Provider Resource Guide Thank you for being a star member of our provider team. However, there will be no members accessing/assigned to the Medicaid portion of the agreement. Q. WellCare of South Carolina will be known as Absolute Total Care as of April 1, 2021. Professional and Institutional Fee-For-Service EDI transactions should be submitted to WellCare of South Carolina Medicaid with Payer ID 14163. 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 participating provider agreement with WellCare will remain in-place after 4/1/2021. This manual sets forth the policies and procedures that providers participating in the Wellcare Prime network are required to follow. If at any time you need help filing one, call us. Please use WellCare Payor ID 14163. PDF AmeriHealth Caritas North Carolina Login - WellCare 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. 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. Members will receive a 90-day transition of care period if the member is receiving ongoing care and treatment. Please see list of services that will require authorization during this time. A. Please use the earliest From Date. In South Carolina, WellCare and Absolute Total Care are joining to better serve you. Please Explore the Site and Get To Know Us. State Health Plan State Claims P.O. Can I continue to see my current WellCare members? Or it can be made if we take too long to make a care decision. Managed Care Claims and Prior Authorizations Submission - NCDHHS 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. We will give you information to help you get the most from your benefits and the services we provide. From Date Institutional Statement Dates on or after April 1, 2021 should be filed to Absolute Total Care. A. Explains rules and state, line of business and CMS-specific regulations regarding 837P EDI transactions. Overview & Resources WellCare of North Carolina partners with providers to develop and deliver high-quality, cost-effective health care solutions. 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. If you think you might have been exposed, contact a doctor immediately. When to File Claims | Cigna Providers can help facilitate timely claim payment by having an understanding of our processes and requirements. 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. Absolute Total Care Box 31224 A. 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. Download the free version of Adobe Reader. Tampa, FL 33631-3372. All billing requirements must be adher ed to by the provider in order to ensure timely processing of claims. P.O. It will tell you we received your grievance. Resources 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. No, Absolute Total Care will continue to operate under the Absolute Total Care name. Date of Occurrence/DOSprior toApril 1, 2021: Processed by 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. A. All dates of service prior to April 1, 2021 should be filed to WellCare of South Carolina. Q. You will need Adobe Reader to open PDFs on this site. Box 8206 You will need Adobe Reader to open PDFs on this site. You may do this in writing or in person. Medicaid Claims Payment Policies Call us to get this form. A hearing officer from the State will decide if we made the right decision. 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. Payments mailed to providers are subject to USPS mailing timeframes. English - Wellcare NC Learn more about how were supporting members and providers. 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). 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. $8v + Yu @bAD`K@8m.`:DPeV @l 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 wish to use a representative, then he or she must complete an Appointment of Representative (AOR) statement. 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. A. Box 100605 Columbia, SC 29260. You can also have a video visit with a doctor using your phone or computer. What will happen to my Participating Provider Agreement with WellCare after 4/1/2021? Q. Q. Copyright 2023 Wellcare Health Plans, Inc. Shop or Enroll in a Plan Frequently Asked Questions Find a Doctor Download Digital ID Card Welcome Allwell Members! Ambetter Timely Filing Limit - Initial Claims, Reconsideration, Appeal With the completion of this transaction, we have created a premier healthcare enterprise focused on government-sponsored healthcare programs. However, there will be no members accessing/assigned to the Medicaid portion of the agreement. Learn how you can help keep yourself and others healthy. Timely Filing Limits - Health Network Solutions WellCare and Absolute Total Care Medicare plans will continue to operate under current brands, product names and provider contracts, until further notice. People of all ages can be infected. Providers interested in joining the Absolute Total Care vision network for routine vision services can contact Envolve Vision at 1-800-531-2818. A. WellCare credentialing cycles will be shared with Absolute Total Care in order to reduce duplicative credentialing in the future. Ambetter from Absolute Total Care - South Carolina. 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. If you need claim filing assistance, please contact your provider advocate. 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 South Carolina Medicaid Provider Resource Guide - WellCare The Medicare portion of the agreement will continue to function in its entirety as applicable. Absolute Total Care will continue to offer Marketplace products under the Ambetter brand. South Carolina : Login Timely filing is when you file a claim within a payer-determined time limit. 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. 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. As of April 1, 2021, all WellCare of South Carolina Medicaid members will transfer to Absolute Total Care. Members will need to talk to their provider right away if they want to keep seeing him/her. 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. Claims | Wellcare We understand that maintaining a healthy community starts with providing care to those who need it most. Contact Wellcare Prime Provider Service at1-855-735-4398if youhave questions. Check out the Interoperability Page to learn more. Professional and Institutional Fee-For-Service EDI transactions should be submitted to WellCare of South Carolina Medicaid with Payer ID 14163. 2) Reconsideration or Claim disputes/Appeals. 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. Explains rules and state, line of business and CMS-specific regulations regarding 837P EDI transactions. WellCare of South Carolina will be known as Absolute Total Care as of April 1, 2021. Where should I submit claims for WellCare Medicaid members? Written notice is not needed if your expedited appeal request is filed verbally. Providers are encouraged to visit the Provider Resources webpagefor manuals, forms, and resources related to claims submission, eligibility, prior authorization, and more. 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. WellCare of South Carolina will be known as Absolute Total Care as of April 1, 2021. A. Absolute Total Care will honor all existing WellCare authorization approvals that include dates of service beyond March 31, 2021. WellCare Medicare members are not affected by this change. If you dont, we will have to deny your request. Please use the From Date Institutional Statement Date. Finding a doctor is quick and easy. We expect this process to be seamless for our valued members, and there will be no break in their coverage. 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! However, there will be no members accessing/assigned to the Medicaid portion of the agreement. endstream endobj startxref 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. Copyright 2023 Wellcare Health Plans, Inc. DOS prior to April 1, 2021: Processed by WellCare. 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. The participating provider agreement with WellCare will remain in-place after April 1, 2021. Providers FAQs | Wellcare Please contact our Provider Services Call Center at 1-888-898-7969. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. Members will receive a 90-day transition of care period if the member is receiving ongoing care and treatment. WellCare claims will be processed according to timely filing provisions in the providers WellCare Participating Provider Agreement. 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 want to ensure that claims are handled as efficiently as possible. Explains how to receive, load and send 834 EDI files for member information. 1096 0 obj <>stream 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. South Carolina DEPARTMENT OF HEALTH AND HUMAN SERVICES Post Office Box 8206 Columbia, South Carolina 29202-8206 www.scdhhs.gov November 24, 2009 ALL . 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. Obstetrician care provided by an out of network Obstetrician will be covered for pregnant members inclusive of post-partum care. A. WellCare Offers New Over-The-Counter Benefit To Its South Carolina 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. 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. Explains rules and state, line of business and CMS-specific regulations regarding 837I EDI transactions. If you request a hearing, the request must: A State Fair Hearing is a legal proceeding. No, Absolute Total Care will continue to operate under the Absolute Total Care name. 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. Integration FAQs | Absolute Total Care 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. Pharmacy services prior to 4/1/2021 must be requested from WellCare South Carolina. We welcome Brokers who share our commitment to compliance and member satisfaction. As of April 1, 2021 Absolute Total Care, a Centene company, is now the health plan for South Carolina Medicaid members. North Carolina PHP Billing Guidance for Local W Code. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. Will Absolute Total Care change its name to WellCare? Claims | Wellcare WellCare of North Carolina will begin to release medical payments to providers beginning July 6, 2021. The state has also helped to set the rules for making a grievance. Claims for services on or after April 1, 2021 should be filed to Absolute Total Care for processing. 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. 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. The onlineProvider Manual represents the most up-to-date information on Absolute Total Cares Medicaid Plan, programs, policies, and procedures. 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. You can file a grievance by calling or writing to us.