To avoid rejections please split the services into two separate claim submissions. 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. We expect this process to be seamless for our valued members, and there will be no break in their coverage. With the completion of this transaction, we have created a premier healthcare enterprise focused on government-sponsored healthcare programs. Explains rules and state, line of business and CMS-specific regulations regarding 837I EDI transactions. The provider needs to contact Absolute Total Care to arrange continuing care. Welcome to Wellcare By Allwell, a Medicare Advantage plan. This manual sets forth the policies and procedures that providers participating in the Wellcare Prime network are required to follow. WellCare of South Carolina will be known as Absolute Total Care as of April 1, 2021. An appeal is a request you can make when you do not agree with a decision we made about your care. Q. 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. The hearing officer will decide whether our decision was right or wrong. Instructions on how to submit a corrected or voided claim. Timely Filing Limit List in Medica Billing (2020 - Medical Billing RCM In South Carolina, WellCare and Absolute Total Care are joining to better serve you. Professional and Institutional Encounter EDI transactions should be submitted to WellCare of South Carolina Medicaid with Payer ID 59354. PDF Claim Filing Manual - First Choice by Select Health of South Carolina If Statement Range is April 2, 2021 through April 10, 2021, please send to Absolute Total Care. 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. 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 A. As of April 1, 2021 Absolute Total Care, a Centene company, is now the health plan for South Carolina Medicaid members. For general questions about claims submissions, call Provider Claims Services at 1-800-575-0418. Contact Wellcare Prime Provider Service at1-855-735-4398if youhave questions. 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 Members will receive a 90-day transition of care period if the member is receiving ongoing care and treatment. Our call centers, including the nurse advice line, are currently experiencing high volume. Members will receive a 90-day transition of care period if the member is receiving ongoing care and treatment. Claims | Wellcare 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. 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. Know the facts about Coronavirus (COVID-19) Our call centers, including the nurse advice line, are currently experiencing high volume. Earliest From Dates prior to 4/1/2021 should be filed to WellCare of South Carolina. %%EOF They are called: State law allows you to make a grievance if you have any problems with us. pst/!+ Y^Ynwb7tw,eI^ If Statement Range is April 2, 2021 through April 10, 2021, please send to Absolute Total 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 Finding a doctor is quick and easy. WellCare of South Carolinawants to ensure that claims are handled as efficiently as possible. For standard requests, if you call in your appeal, you must follow up with a written, signed one, within thirty calendar days. Absolute Total Care will honor all existing WellCare authorization approvals that include dates of service beyond March 31, 2021. 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. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. We will send you another letter with our decision within 90 days or sooner. Q. To write us, send mail to: You can fax it too. Shop or Enroll in a Plan Frequently Asked Questions Find a Doctor Download Digital ID Card Welcome Allwell Members! Q. You will need Adobe Reader to open PDFs on this site. Kasapulam ti tulong? Q. Obstetrician care provided by an out of network Obstetrician will be covered for pregnant members inclusive of post-partum care. A. With the completion of this transaction, we have created a premier healthcare enterprise focused on government-sponsored healthcare programs. Absolute Total Care will continue to offer Marketplace products under the Ambetter brand. You can ask in writing for a State Fair Hearing (hearing, for short). 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. 2) Reconsideration or Claim disputes/Appeals. We will give you information to help you get the most from your benefits and the services we provide. This person has all beneficiary rights and responsibilities during the appeal process. Electronic and Paper Claims Submissions; Institutional Claims/Encounter Guides. 2023 Medicare and PDP Compare Plans and Enroll Now. However, there will be no members accessing/assigned to the Medicaid portion of the agreement. This includes providing assistance with accessing interpreter services and hearing impaired . Box 31384 WellCare of South Carolina will be known as Absolute Total Care as of April 1, 2021. You can file a grievance by calling or writing to us. It will let you know we received your appeal. Q. A. Always verify timely filing requirements with the third party payor. Keep yourself informed about Coronavirus (COVID-19.) Please be sure to use the correct line of business prior authorization form for prior authorization requests. Members can continue to receive services from their current WellCare provider as long as they remain covered under WellCare. Claims will be processed according to timely filing provisions in the providers Absolute Total Care Participating Provider Agreement. Tampa, FL 33631-3384. Copyright 2023 Wellcare Health Plans, Inc. If you wish to use a representative, then he or she must complete an Appointment of Representative (AOR) statement. We are glad you joined our family! Welcome to WellCare of South Carolina! Learn more about how were supporting members and providers. Box 3050 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. Beginning. Example of how to properly split claim that span the cutover date of April 1, 2021: Q. Box 100605 Columbia, SC 29260. A. 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. You can do this at any time during your appeal. South Carolina Medicaid Provider Resource Guide - WellCare P.O. We will review it and send you a decision letter within 30 calendar days from receiving your appeal. The second level review will follow the same process and procedure outlined for the initial review. P.O. This gives members time to establish with a new provider in the network and ensure that they have continuity of care. We are proud to announce that WellCare is now part of the Centene Family. 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. Wfu neebybfgnh bgWfulnybfgC South Carolina Medicaid Provider Resource Guide Thank you for being a star member of our provider team. We're here for you. It is 30 days to 1 year and more and depends on . Claims will be processed according to timely filing provisions in the providers WellCare Participating Provider Agreement. you have another option. Absolute Total Care will honor those authorizations. You can file an appeal if you do not agree with our decision. Please see list of services that will require authorization during this time. Q. Box 31224 Q. 941w*)bF iLK\c;nF mhk} N .7$* P!70 *I;Rox3 ] LS~. Forgot Your Password? Providers interested in joining the Absolute Total Care vision network for routine vision services can contact Envolve Vision at 1-800-531-2818. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. All transitioning Medicaid members will receive a welcome packet and new ID card from Absolute Total Care in March 2021 and will use the Absolute Total Care ID card to get prescriptions and access health care services starting April 1, 2021. You or your authorized representative will tell the hearing officer why you think we made the wrong decision. Claims will be processed according to timely filing provisions in the providers WellCare Participating Provider Agreement. For dates of service prior to April 1, 2021: All paper claim submissions can be mailed to: WellCare Health Plans Wellcare uses cookies. Providers interested in joining the Absolute Total Care Provider Network should submit a request to Network Development and Contracting via email at. March 14-March 31, 2021, please send to WellCare. ?-}++lz;.0U(_I]:3O'~3-~%-JM A. hbbd``b`$= $ A grievance is when you tell us about a concern you have with our plan. PDF AmeriHealth Caritas North Carolina Wellcare uses cookies. Q. We will notify you orally and in writing. We will continue covering your medical services during your appeal request and State Fair Hearing if all of the following are meet. WellCare and Absolute Total Care Medicare plans will continue to operate under current brands, product names and provider contracts, until further notice. To do so by phone, call Member Services at 1-888-588-9842 (TTY1-877-247-6272). Will my existing WellCare patients be assigned to my Absolute Total Care Panel? If you need claim filing assistance, please contact your provider advocate. However, as of April 1, 2021, all WellCare of South Carolina Medicaid members will become Absolute Total Care members. 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. Select your topic and plan and click "Chat Now!" to chat with a live agent! It is called a "Notice of Adverse Benefit Determination" or "NABD." The participating provider agreement with WellCare will remain in-place after 4/1/2021. Register now at https://www.payspanhealth.comor contact PaySpan at providersupport@payspanhealth.com, or 877-331-7154. Timely Filing Beginning October 1, 2020, the Timely Filing submission requirements specified in each Provider's Meridian Medicare contract will be enforced. Timely Filing Limits for all Insurances updated (2023) If you file a grievance or an appeal, we must be fair. We may apply a 14 day extension to your grievance resolution. Tampa, FL 33631-3372. Additionally, WellCare will have a migration section on their provider page at publishing FAQs. 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. Contact Us Y0020_WCM_100876E Last Updated On: 10/1/2022 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). 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 ask for a State Fair Hearing after we make our appeal decision. You, your friend, a relative, legal counsel or other spokesperson who has your written consent may ask for a State Fair Hearing. WellCare of North Carolina will begin to release medical payments to providers beginning July 6, 2021. 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. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. 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. 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. However, there will be no members accessing/assigned to the Medicaid portion of the agreement. Utilize interactive health and wellness tools to help you manage conditions, improve your health and save money. Box 31224 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. There is a lot of insurance that follows different time frames for claim submission. A. If you dont, we will have to deny your request. Wellcare uses cookies. What is the Rx BIN and Group Number for WellCare members transitioning to Absolute Total Care on April 1, 2021? A. You will get a letter from us when any of these actions occur. The onlineProvider Manual represents the most up-to-date information on Absolute Total Cares Medicaid Plan, programs, policies, and procedures. Tampa, FL 33631-3372. A. Absolute Total Care will continue to offer Marketplace products under the Ambetter brand. Those who attend the hearing include: You can also request to have your hearing over the phone. * Username. The Medicare portion of the agreement will continue to function in its entirety as applicable. 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. the timely filing limits due to the provider being unaware of a beneficiary's coverage. How do I determine if a professional or an outpatient bill type institutional submission should be filed to WellCare or Absolute Total Care? and Human Services Reimbursement Policies PROVIDERS NOTE:Please send Corrected Claims as normal submissions via electronic or paper. Coronavirus Disease 2019 (COVID-19) causes respiratory illness in people and can spread from person to person. WellCare offers participating providers EFT and ERA services at no charge through PaySpan Health. Federal Employee Program (FEP) Federal Employee Program P.O. $8v + Yu @bAD`K@8m.`:DPeV @l Payments mailed to providers are subject to USPS mailing timeframes. Exceptions to the one-year time limit: a) Medicare Cost Sharing Claims . Claims Submission, Correspondence and Contact Resources will stay the same for the Medicare line of business. Search for primary care providers, hospitals, pharmacies, and more! By continuing to use our site, you agree to our Privacy Policy and Terms of Use. 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. Our health insurance programs are committed to transforming the health of the community one individual at a time. 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. 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. Claim Filing Manual - First Choice by Select Health of South Carolina 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. 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. 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. Contact Absolute Total Care Provider Service at1-866-433-6041if youhave questions. 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. 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. Download the free version of Adobe Reader. To do so by phone, call Member Services at 1-888-588-9842 (TTY1-877-247-6272). In this section, we will explain how you can tell us about these concerns/grievances. Please contact our Provider Services Call Center at 1-888-898-7969. 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. This manual sets forth the policies and procedures that providers participating in the Absolute Total Carenetwork are required tofollow. Examples: If Statement Range is March 14, 2021 through April 3, 2021, please send to WellCare. South Carolina | Wellcare 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. Providers will follow Absolute Total Care Medicaid policies and procedures for all services, inclusive of medical, behavioral, and pharmaceutical benefits, provided to WellCare Medicaid members transitioning to Absolute Total Care for dates of service on or after April 1, 2021. UnitedHealthcare Community Plan of North Carolina Homepage The timely filing limit is the time duration from service rendered to patients and submitting claims to the insurance companies. HealthPlan - redirect.centene.com - Allwell Medicare %PDF-1.6 % A. Q. A. WellCare Offers New Over-The-Counter Benefit To Its South Carolina Managed Care Claims and Prior Authorizations Submission - NCDHHS We cannot disenroll you from our plan or treat you differently. Claims for services prior to April 1, 2021 should be filed to WellCare for processing. From Date Institutional Statement Dates on or after 4/1/2021 should be filed to Absolute Total Care. If Medicare is the primary payer, timely filing is determined from the processing date indicated on the primary carrier's explanation of benefit (EOB) If Medicare is the Secondary Payer (MSP), the initial claim must be submitted to the primary payer within Cigna's timely filing period. Claims Department 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. Timely Filing Limits for all Insurances updated (2023) - Bcbsproviderphonenumber Timely Filing Limits for all Insurances updated (2023) One of the common and popular denials is passed the timely filing limit. As of April 1, 2021, WellCare will no longer be a separate plan option offered by South Carolina Healthy Connections Choices. 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. 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 have licensed clinicians available to speak with you and to connect you to the support you need to feel better. P.O. WellCare has partnered with Change Healthcare as our preferred EDI Clearinghouse. 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 Thanka kaa yoa Tufrbeau ingsnh ngetfu South Caralaita nouMa mpvd. Provider can't require members to appoint them as a condition of getting services. 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.
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