The participating provider agreement with WellCare will remain in-place after 4/1/2021. 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. Send your written appeal to: We must have your written consent before someone can file an appeal for you. We have licensed clinicians available to speak with you and to connect you to the support you need to feel better. 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 provider as if the primary care provideris in network with Absolute Total Care. 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. Box 31224 Instructions on how to submit a corrected or voided claim. 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. To have someone represent you, you must complete an Appointment of Representative (AOR) form. Instructions on how to submit a corrected or voided claim. Initial Claims: 120 Days from the Date of Service. Reconsideration or Claim Disputes/Appeals: You and the person you choose to represent you must sign the AOR form. Explains rules and state, line of business and CMS-specific regulations regarding 837P EDI transactions. Date of Occurrence/DOSApril 1, 2021 and after: Processed by Absolute Total Care. A. 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. Pharmacy services prior to 4/1/2021 must be requested from WellCare South Carolina. 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. Box 8206 Columbia, SC 29202-8206 Or call 1-800-763-9087. You and the person you choose to represent you must sign the AOR statement. For dates of service prior to April 1, 2021: All paper claim submissions can be mailed to: WellCare Health Plans 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. Wellcare uses cookies. However, there will be no members accessing/assigned to the Medicaid portion of the agreement. We're here for you. 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 A. WellCare of North Carolina partners with providers to develop and deliver high-quality, cost-effective health care solutions. You or your authorized representative can review the information we used to make our decision. We will give you information to help you get the most from your benefits and the services we provide. Forgot Your Password? DOS April 1, 2021 and after: Processed by Absolute Total Care. Here are some guides we created to help you with claims filing. From Date Institutional Statement Dates prior to April 1, 2021 should be filed to WellCare of South Carolina. Explains rules and state, line of business and CMS-specific regulations regarding 837P EDI transactions. If at any time you need help filing one, call us. Ancillary Claims Filing Reminders; ClaimsXten TM: Correct Coding Initiative Reference Guide; Inpatient Non-Reimbursable Charges/Unbundling Policy Please use the earliest From Date. With the completion of this transaction, we have created a premier healthcare enterprise focused on government-sponsored healthcare programs. Absolute Total Care will honor those authorizations. 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 Addakam ditoy para kenka. Exceptions to the one-year time limit: a) Medicare Cost Sharing Claims . Download the free version of Adobe Reader. No, Absolute Total Care will continue to operate under the Absolute Total Care name. It will tell you we received your grievance. Farmington, MO 63640-3821. Shop or Enroll in a Plan Frequently Asked Questions Find a Doctor Download Digital ID Card Welcome Allwell Members! We will notify you orally and in writing. 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. 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. 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. \{-w{,xI202100$0*bZf ,X AayhP3pYla" e 3G& `eoT#@ *;d For current information, visit the Absolute Total Care website. You can file the grievance yourself. Or you can have someone file it for you. Claims will be processed according to timely filing provisions in the providers Absolute Total Care Participating Provider Agreement. Beginning. the timely filing limits due to the provider being unaware of a beneficiary's coverage. 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. These SNP plans provide benefits beyond Original Medicare, and may include transportation to medical appointments and vision exams. Q. March 14-March 31, 2021, please send to WellCare. Can I continue to see my current WellCare members? They must inform their vendor of AmeriHealth Caritas . 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. Ambetter Timely Filing Limit of : 1) Initial Claims. Select Health Claims must be filed within 12 months from the date of service. WellCare claims will be processed according to timely filing provisions in the providers WellCare Participating Provider Agreement. B^E{h#XYQv;[ny3Hha1yx4v.sBy jWacQzyL.kHhwtQ~35!Rh#)p+sj31LcC)4*Z:IWIG@WTD- )n,! If an authorization is needed, you can log in to the Secure Provider Portalto submit and confirm authorizations. Section 1: General Information. Claims for services on or after April 1, 2021 should be filed to Absolute Total Care for processing. If you ask for a fast appeal and we decide that one is not needed, we will: You or your authorized representative can give us more information if you think itll help your appeal (regular or fast). You may do this in writing or in person. You can ask for a State Fair Hearing after we make our appeal decision. A. %PDF-1.6 % We are glad you joined our family! Please use the Earliest From Date. Reimbursement Policies Providers interested in joining the Absolute Total Care Provider Network should submit a request to Network Development and Contracting via email at. Members can continue to receive services from their current WellCare provider as long as they remain covered under WellCare. 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. To do this: Be sure to ask us to continue your benefits within the 10 calendar day time frame. We understand that maintaining a healthy community starts with providing care to those who need it most. 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. The way your providers or others act or treat you. You may request a State Fair Hearing at this address: South Carolina Department of Health By continuing to use our site, you agree to our Privacy Policy and Terms of Use. You will get a letter from us when any of these actions occur. The timely filing limit is the time duration from service rendered to patients and submitting claims to the insurance companies. 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. Register now at https://www.payspanhealth.com or contact PaySpan at providersupport@payspanhealth.com, or 877-331-7154. 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. Q. However, as of April 1, 2021, all WellCare of South Carolina Medicaid members will become Absolute Total Care members. Those who attend the hearing include: You can also request to have your hearing over the phone. 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. From Date Institutional Statement Dates prior to 4/1/2021 should be filed to WellCare of South Carolina. WellCare offers participating providers EFT and ERA services at no charge through PaySpan Health. Claims Submission, Correspondence and Contact Resources will stay the same for the Medicare line of business. Explains how to receive, load and send 834 EDI files for member information. We are proud to announce that WellCare is now part of the Centene Family. Providers can help facilitate timely claim payment by having an understanding of our processes and requirements. If an authorization is needed, you can log in to the Secure Provider Portal at absolutetotalcare.com to submit and confirm authorizations. WellCare is the health care plan that puts you in control. An appeal may be filed within 60 calendar days from the date on the Adverse Benefit Determination Notice. A grievance is when you tell us about a concern you have with our plan. Will my existing WellCare patients be assigned to my Absolute Total Care Panel? Pharmacy services prior to April 1, 2021 must be requested from WellCare of South Carolina. 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. 3) Coordination of Benefits. Q: What is Absolute Total Cares Transition/Continuity of Care Policy? As of April 1, 2021, all WellCare of South Carolina Medicaid members will transfer to Absolute Total Care. Q. Examples: If Statement Range is March 14, 2021 through April 3, 2021, please send to WellCare. Will Absolute Total Care continue to offer Medicare and Marketplace products? 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. Will WellCare continue to offer current products or Medicare only? Wellcare uses cookies. All dates of service on or after 4/1/2021 should be filed to Absolute Total Care. BlueCross BlueShield of South Carolina Piedmont Service Center P.O. Kasapulam ti tulong? A. Where should I submit claims for WellCare Medicaid members that transition to Absolute Total Care? Claims will be processed according to timely filing provisions in the providers Absolute Total Care Participating Provider Agreement. You or your authorized representative will tell the hearing officer why you think we made the wrong decision. Please use the From Date Institutional Statement Date. Claim Filing Manual - First Choice by Select Health of South Carolina Box 3050 Claims for services prior to April 1, 2021 should be filed to WellCare for processing. 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. You may file your second level grievance review within 30 days of receiving your grievance decision letter. 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. If you request a hearing, the request must: A State Fair Hearing is a legal proceeding. 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. 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. 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. To avoid rejections please split the services into two separate claim submissions. As of April 1, 2021 Absolute Total Care, a Centene company, is now the health plan for South Carolina Medicaid members. South Carolina Department of Health and Human Services Division of Appeals and Hearings P.O. Explains rules and state, line of business and CMS-specific regulations regarding 837I EDI transactions. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. Q. The Claim Reconsideration process is an informal claim review, and is not a substitute for an appeal of a final agency decision. 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. Contact Wellcare Prime Provider Service at 1-855-735-4398 if you have questions. Copyright 2023 Wellcare Health Plans, Inc. (This includes your PCP or another provider.) Q. For additional information, questions or concerns, please contact your local Provider Network Management Representative. 1,flQ*!WLOmsmz\D;I5BI,yA#z!vYQi5'fedREF40 b666q1(UtUJJ.i` (T/@E An appeal is a request you can make when you do not agree with a decision we made about your care. $8v + Yu @bAD`K@8m.`:DPeV @l you have another option. Providers are encouraged to visit the Provider Resources webpagefor manuals, forms, and resources related to claims submission, eligibility, prior authorization, and more. People of all ages can be infected. You can file your appeal by calling or writing to us. Symptoms are flu-like, including: Fever Coughing 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.
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