A provider can act for a member in hearings with the member's written permission in advance. Payments mailed to providers are subject to USPS mailing timeframes. The Claim Reconsideration process is an informal claim review, and is not a substitute for an appeal of a final agency decision. Our call centers, including the nurse advice line, are currently experiencing high volume. 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. Box 6000 Greenville, SC 29606. * Password. Tampa, FL 33631-3372. Claim Filing Manual - First Choice by Select Health of South Carolina You will get a letter from us when any of these actions occur. P.O. It will let you know we received your appeal. We will continue covering your medical services during your appeal request and State Fair Hearing if all of the following are meet. To avoid rejections please split the services into two separate claim submissions. Please use WellCare Payor ID 14163. The participating provider agreement with WellCare will remain in-place after April 1, 2021. Our fax number is 1-866-201-0657. We expect this process to be seamless for our valued members and there will be no break in their coverage. The provider needs to contact Absolute Total Care to arrange continuing care. B^E{h#XYQv;[ny3Hha1yx4v.sBy jWacQzyL.kHhwtQ~35!Rh#)p+sj31LcC)4*Z:IWIG@WTD- )n,! As of April 1, 2021, all WellCare of South Carolina Medicaid members will become Absolute Total Care members. 1,flQ*!WLOmsmz\D;I5BI,yA#z!vYQi5'fedREF40 b666q1(UtUJJ.i` (T/@E From Date Institutional Statement Dates on or after 4/1/2021 should be filed to Absolute Total Care. Please be sure to use the correct line of business prior authorization form for prior authorization requests. Our health insurance programs are committed to transforming the health of the community one individual at a time. hbbd``b`$= $ Forms. Paper Claim Submission Submit paper claims to: WellCare Health Plans Electronic Claim Submission To initiate electronic claims, both in-network and out-of-network providers should contact their practice management software vendor or EDI software vendor. 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. Please make sure you ask your members for a copy of their Absolute Total Care and Healthy Connections Choices Medicaid ID cards before each visit. There is a lot of insurance that follows different time frames for claim submission. Select your topic and plan and click "Chat Now!" to chat with a live agent! 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. Send your written appeal to: We must have your written consent before someone can file an appeal for you. 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. WellCare has partnered with Change Healthcare as our preferred EDI Clearinghouse. How are WellCare Medicaid member authorizations being handled after April 1, 2021? WellCare Medicare members are not affected by this change. You can ask in writing for a State Fair Hearing (hearing, for short). 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. 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? Please contact our Provider Services Call Center at 1-888-898-7969. However, as of April 1, 2021, all WellCare of South Carolina Medicaid members will become Absolute Total Care members. Timely filing limits vary. If an authorization is needed, you can log in to the Secure Provider Portal at absolutetotalcare.com to submit and confirm authorizations. 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. WellCare claims will be processed according to timely filing provisions in the providers WellCare Participating Provider Agreement. However, there will be no members accessing/assigned to the Medicaid portion of the agreement. 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. Additionally, WellCare will have a migration section on their provider page at publishing FAQs. For additional information, questions or concerns, please contact your local Provider Network Management Representative. First Choice can accept claim submissions via paper or electronically (EDI). Claims will be processed according to timely filing provisions in the providers Absolute Total Care Participating Provider Agreement. 8h} \x p`03 1z`@+`~70 G ~Ws5Puick79,4 ,O5@?O-Gr'|5Oj:v6/` They are called: State law allows you to make a grievance if you have any problems with us. Providers interested in joining the Absolute Total Care vision network for routine vision services can contact Envolve Vision at 1-800-531-2818. It is called a "Notice of Adverse Benefit Determination" or "NABD." UnitedHealthcare Dual Complete Special Needs Plan UnitedHealthcare Dual Complete Special Needs Plans (SNP) offer benefits for people with both Medicare and Medicaid. 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. People of all ages can be infected. Copyright 2023 Wellcare Health Plans, Inc. Q. 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. 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. Additionally, WellCare will have a migration section on their provider webpage publishing FAQs. Wellcare wants to ensure that claims are handled as efficiently as possible. Shop or Enroll in a Plan Frequently Asked Questions Find a Doctor Download Digital ID Card Welcome Allwell Members! Claims Department Can I continue to see my current WellCare members? WellCare of North Carolina partners with providers to develop and deliver high-quality, cost-effective health care solutions. As of April 1, 2021, WellCare will no longer be a separate plan option offered by South Carolina Healthy Connections Choices. 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. WellCare offers participating providers EFT and ERA services at no charge through PaySpan Health. You can do this at any time during your appeal. 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. State Health Plan State Claims P.O. Know the facts about Coronavirus (COVID-19) Our call centers, including the nurse advice line, are currently experiencing high volume. 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 Medicare portion of the agreement will continue to function in its entirety as applicable. 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. 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. As of April 1, 2021 Absolute Total Care, a Centene company, is now the health plan for South Carolina Medicaid members. 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. Providers are encouraged to visit the Provider Resources webpagefor manuals, forms, and resources related to claims submission, eligibility, prior authorization, and more. Guides Filing Claims with WellCare. Members will need to talk to their provider right away if they want to keep seeing him/her. Contact Wellcare Prime Provider Service at 1-855-735-4398 if you have questions. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. Contact Absolute Total Care Provider Service at1-866-433-6041if youhave questions. Q. Attn: Grievance Department A. Call us to get this form. You will receive an acknowledgement letter within 5 business days, and we will send you a resolution within 90 calendar days. 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. $8v + Yu @bAD`K@8m.`:DPeV @l We process check runs daily, with the exception of Sundays, National Holidays, and the last day of the month. Pregnant members receiving care from an out of network Obstetrician can continue to see their current Obstetrician until after the baby is born. You will have a limited time to submit additional information for a fast appeal. The Medicare portion of the agreement will continue to function in its entirety as applicable. The second level review will follow the same process and procedure outlined for the initial review. We are proud to announce that WellCare is now part of the Centene Family. In this section, we will explain how you can tell us about these concerns/grievances. Section 1: General Information. Instructions on how to submit a corrected or voided claim. This includes providing assistance with accessing interpreter services and hearing impaired . WellCare claims will be processed according to timely filing provisions in the providers WellCare Participating Provider Agreement. 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. We are glad you joined our family! You and the person you choose to represent you must sign the AOR form. The onlineProvider Manual represents the most up-to-date information on Absolute Total Cares Medicaid Plan, programs, policies, and procedures. Box 600601 Columbia, SC 29260. This must be done within 120 days from the date of Notice of Appeal Resolution you received from us. To do this: A. Pharmacy services prior to 4/1/2021 must be requested from WellCare South Carolina. A. We expect this process to be seamless for our valued members, and there will be no break in their coverage. ?-}++lz;.0U(_I]:3O'~3-~%-JM Medicaid Claims Payment Policies We are proud to announce that WellCare is now part of the Centene Family. We want to ensure that claims are handled as efficiently as possible. Earliest From Dates on or after April 1, 2021 should be filed to Absolute Total Care. They must inform their vendor of AmeriHealth Caritas . Pharmacy services prior to April 1, 2021 must be requested from WellCare of South Carolina. 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. Earliest From Dates on or after 4/1/2021 should be filed to Absolute Total Care. We want you to let us know right away if you have any questions, grievances or problems with your covered services or the care you receive. 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. Box 31224 Will Absolute Total Care continue to offer Medicare and Marketplace products? With the completion of this transaction, we have created a premier healthcare enterprise focused on government-sponsored healthcare programs. WellCare claims will be processed according to timely filing provisions in the providers WellCare Participating Provider Agreement. Box 8206 Columbia, SC 29202-8206 Or call 1-800-763-9087. Member Sign-In. Earliest From Dates prior to 4/1/2021 should be filed to WellCare of South Carolina. Please Explore the Site and Get To Know Us. A. Box 3050 Yes, Absolute Total Care and WellCare will continue to offer Medicare products under their current brands and product names, until further notice. %%EOF 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. Here are some guides we created to help you with claims filing. Absolute Total Care will continue to offer Marketplace products under the Ambetter brand. 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. We may apply a 14 day extension to your grievance resolution. Absolute Total Care will honor those authorizations. Obstetrician care provided by an out of network Obstetrician will be covered for pregnant members inclusive of post-partum care. 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 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. Claims will be processed according to timely filing provisions in the providers WellCare Participating Provider Agreement. WellCare of North Carolina Medicaid providers are not required to obtain an authorization for professional services for the 90-day post-go live period from July 1, 2021 through September 28, 2021. You or your authorized representative will tell the hearing officer why you think we made the wrong decision. 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. 0 However, as of April 1, 2021, all WellCare of South Carolina Medicaid members will become Absolute Total Care members. Professional and Institutional Fee-For-Service EDI transactions should be submitted to WellCare of South Carolina Medicaid with Payer ID 14163. S< If Statement Range is April 2, 2021 through April 10, 2021, please send to Absolute Total Care. Examples: If Statement Range is March 14, 2021 through April 3, 2021, please send to WellCare. Tampa, FL 33631-3372. 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. Please use the Earliest From Date. Box 8206 Members can continue to receive services from their current WellCare provider as long as they remain covered under WellCare. If you are unable to view PDFs, please download Adobe Reader. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. 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. We are committed to improving the quality of life of our millions of members, who often include some of our nations most vulnerable populations. 1071 0 obj <>/Filter/FlateDecode/ID[<87133B316ADA4BDD8B85BA48A489D34F>]/Index[1044 53]/Info 1043 0 R/Length 117/Prev 692690/Root 1045 0 R/Size 1097/Type/XRef/W[1 2 1]>>stream We cannot disenroll you from our plan or treat you differently. Absolute Total Care will honor all existing WellCare authorization approvals that include dates of service beyond March 31, 2021. UHC Community TFL - Timely filing Limit: 120 Days: Unitedhealthcare TFL - Timely filing Limit: Participating Providers: 90 days Non Participating Providers: 180 Days If its secondary payer: 90 days from date of Primary Explanation of Benefits Unitedhealthcare timely filing limit for appeals: 12 months from original claim determination Q. Incorrect forms will not be considered and may lead to further delays in processing prior authorization requests. 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 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 on or after April 1, 2021 should be filed to Absolute Total Care. Q. Effective January 1, 2015 the South Carolina Department of Health and Human Services (SCDHHS) will implement a Claim Reconsideration Policy. If you dont, we will have to deny your request. 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. Farmington, MO 63640-3821. 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. How do I bill a professional submission with services spanning before and after 04/01/2021? pst/!+ Y^Ynwb7tw,eI^ 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. WellCare of South Carolina will be known as Absolute Total Care as of April 1, 2021. For current information, visit the Absolute Total Care website. Professional and Institutional Encounter EDI transactions should be submitted to WellCare of South Carolina Medicaid with Payer ID 59354. Need an account? Wellcare uses cookies. The state has also helped to set the rules for making a grievance. WellCare of South Carolinawants to ensure that claims are handled as efficiently as possible. WellCare and Absolute Total Care Medicare plans will continue to operate under current brands, product names and provider contracts, until further notice. However, there will be no members accessing/assigned to the Medicaid portion of the agreement. 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. Register now at https://www.payspanhealth.comor contact PaySpan at providersupport@payspanhealth.com, or 877-331-7154. the timely filing limits due to the provider being unaware of a beneficiary's coverage. A. To do so by phone, call Member Services at 1-888-588-9842 (TTY1-877-247-6272). How will credentialing/recredentialing be handled by Absolute Total Care if a provider was recently credentialed/recredentialed by WellCare? A. WellCare credentialing cycles will be shared with Absolute Total Care in order to reduce duplicative credentialing in the future. WellCare of South Carolina will be known as Absolute Total Care as of April 1, 2021. 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. A. Select Health Claims must be filed within 12 months from the date of service. What will happen to unresolved claims prior to the membership transfer? Will WellCare continue to offer current products or Medicare only? WellCare offers participating providers EFT and ERA services at no charge through PaySpan Health. We expect this process to be seamless for our valued members and there will be no break in their coverage. 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. In South Carolina, WellCare and Absolute Total Care are joining to better serve you. Overview & Resources WellCare of North Carolina partners with providers to develop and deliver high-quality, cost-effective health care solutions. Box 100605 Columbia, SC 29260. 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. 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. 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. 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. Only you or your authorizedrepresentative can ask for a State Fair Hearing. All dates of service prior to 4/1/2021 should be filed to WellCare of South Carolina. Learn more about how were supporting members and providers. 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. Kasapulam ti tulong? %PDF-1.6 % A. Claims for services prior to April 1, 2021 should be filed to WellCare for processing. Pregnant members receiving care from an out-of-network Obstetrician can continue to see their current obstetrician until after the baby is born. 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. PROVIDERS NOTE:Please send Corrected Claims as normal submissions via electronic or paper. Q. Division of Appeals and Hearings Coronavirus Disease 2019 (COVID-19) causes respiratory illness in people and can spread from person to person. 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.

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