Providers are encouraged to visit the Provider Resources webpagefor manuals, forms, and resources related to claims submission, eligibility, prior authorization, and more. Explains how to receive, load and send 834 EDI files for member information. 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. 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. You can file a grievance by calling or writing to us. As of April 1, 2021 Absolute Total Care, a Centene company, is now the health plan for South Carolina Medicaid members. No, Absolute Total Care will continue to operate under the Absolute Total Care name. South Carolina DEPARTMENT OF HEALTH AND HUMAN SERVICES Post Office Box 8206 Columbia, South Carolina 29202-8206 www.scdhhs.gov November 24, 2009 ALL . Outpatient Prior Authorization Form (PDF) Inpatient Prior Authorization Form (PDF) Electronic and Paper Claims Submissions; Institutional Claims/Encounter Guides. You may file your second level grievance review within 30 days of receiving your grievance decision letter. WellCare claims will be processed according to timely filing provisions in the providers WellCare Participating Provider Agreement. 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. Date of Occurrence/DOSApril 1, 2021 and after: Processed by Absolute Total Care. Tampa, FL 33631-3372. We would like to help your billing department get your EDI (claims and real time) transactions processed as efficiently as possible. With the completion of this transaction, we have created a premier healthcare enterprise focused on government-sponsored healthcare programs. Your second-level review will be performed by person(s) not involved in the first review. Register now at https://www.payspanhealth.comor contact PaySpan at providersupport@payspanhealth.com, or 877-331-7154. Contact Wellcare Prime Provider Service at1-855-735-4398if youhave questions. Q. 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. 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. 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 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. When you receive your notification of WellCares grievance resolution, and you are dissatisfied with the resolution regarding adverse decisions that affect your ability to receive benefits, access to care, access to services or payment for care of services, you may request a second level review with WellCare. L]4(f4/pn~YTZSp-5/O*F)e~p:a6o{x8r WellCare offers participating providers EFT and ERA services at no charge through PaySpan Health. Effective January 1, 2015 the South Carolina Department of Health and Human Services (SCDHHS) will implement a Claim Reconsideration Policy. 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. Or you can have someone file it for you. Q: What is Absolute Total Cares Transition/Continuity of Care Policy? Claims | Wellcare Additionally, WellCare will have a migration section on their provider webpage publishing FAQs. To do this: Be sure to ask us to continue your benefits within the 10 calendar day time frame. You will need Adobe Reader to open PDFs on this site. Code of Laws - Title 42 - South Carolina General Assembly You may do this in writing or in person. South Carolina | Medicaid Ancillary Claims Filing Reminders; ClaimsXten TM: Correct Coding Initiative Reference Guide; Inpatient Non-Reimbursable Charges/Unbundling Policy Q. Medicaid North Carolina | Healthy Blue of North Carolina 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. In South Carolina, WellCare and Absolute Total Care are joining to better serve you. It is 30 days to 1 year and more and depends on . Box 31384 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. If Statement Range is March 14, 2021 through April 3, 2021, please send to WellCare. To do so by phone, call Member Services at 1-888-588-9842 (TTY1-877-247-6272). Prior authorizations issued by WellCare for dates of service on or after April 1, 2021 will transfer with the members eligibility to Absolute Total Care. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. 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. Explains rules and state, line of business and CMS-specific regulations regarding 837P EDI transactions. What will happen to my Participating Provider Agreement with WellCare after 4/1/2021? 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. Q. This includes providing assistance with accessing interpreter services and hearing impaired . The state has also helped to set the rules for making a grievance. If you request a hearing, the request must: A State Fair Hearing is a legal proceeding. We are proud to announce that WellCare is now part of the Centene Family. Keep yourself informed about Coronavirus (COVID-19.) We will also send you a letter with our decision within 72 hours from receiving your appeal. 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 uses cookies. 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. Symptoms are flu-like, including: Fever Coughing Home | Wellcare Claims for services on or after April 1, 2021 should be filed to Absolute Total Care for processing. 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 March 15, 2021. If your services are continued during an appeal or a hearing, you can keep getting them until: If the hearing is decided in your favor, well approve and pay for the care that is needed. WellCare 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. Claims will be processed according to timely filing provisions in the providers Absolute Total Care Participating Provider Agreement. Contact Absolute Total Care Provider Service at1-866-433-6041if youhave questions. Providers interested in joining the Absolute Total Care Provider Network should submit a request to Network Development and Contracting via email at atc_contracting@centene.com. Q. Q. Only you or your authorizedrepresentative can ask for a State Fair Hearing. 1,flQ*!WLOmsmz\D;I5BI,yA#z!vYQi5'fedREF40 b666q1(UtUJJ.i` (T/@E It can also be about a provider and/or a service. Welcome to WellCare Provider Login Contact Us Join Our Network Medicaid Medicare Tools News and Education AcariaHealth Specialty Pharmacy Pharmacy Forms Request for Drug Coverage Request to Review Drug Coverage Denial . Wfu neebybfgnh bgWfulnybfgC South Carolina Medicaid Provider Resource Guide Thank you for being a star member of our provider team. Provider can't require members to appoint them as a condition of getting services. Claims for services on or after April 1, 2021 should be filed to Absolute Total Care for processing. Absolute Total Care Earliest From Dates on or after 4/1/2021 should be filed to Absolute Total Care. As of April 1, 2021, all WellCare of South Carolina Medicaid members will transfer to Absolute Total Care. P.O. This manual sets forth the policies and procedures that providers participating in the Wellcare Prime network are required to follow. Our toll-free fax number is 1-877-297-3112. WellCare of South Carolina will be known as Absolute Total Care as of April 1, 2021. WellCare Medicare members are not affected by this change. 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. These materials are for informational purposes only. and Human Services Please use the Earliest From Date. You or your authorized representative will tell the hearing officer why you think we made the wrong decision. 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. A. If you wish to use a representative, then he or she must complete an Appointment of Representative (AOR) statement. The onlineProvider Manual represents the most up-to-date information on Wellcare Prime by Absolute Total Care (Medicare-Medicaid Plan), programs, policies, and procedures. 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! Welcome to WellCare of South Carolina! 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. Q. HealthPlan - redirect.centene.com - Allwell Medicare You can do this at any time during your appeal. | WellCare 837 Institutional Encounter 5010v Guide Download the free version of Adobe Reader. WellCare Offers New Over-The-Counter Benefit To Its South Carolina The annual flu vaccine helps prevent the flu. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. 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. 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 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. Members will receive a 90-day transition of care period if the member is receiving ongoing care and treatment. Select Health Claims must be filed within 12 months from the date of service. P.O. 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. Here you will find the tools and resources you need to help manage your submission of claims and receipt of payments. It was a smart move. We will do this as quickly as possible as but no longer than 72-hours from the decision. A. Claims Submission | BlueCross BlueShield of South Carolina For additional information, questions or concerns, please contact your local Provider Network Management Representative. Timely Filing Limit of Insurances - Revenue Cycle Management Ambetter Timely Filing Limit - Initial Claims, Reconsideration, Appeal Q. 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. 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. You will receive an acknowledgement letter within 5 business days, and we will send you a resolution within 90 calendar days. This must be done within 120 days from the date of Notice of Appeal Resolution you received from us. WellCare Medicare members are not affected by this change. \{-w{,xI202100$0*bZf ,X AayhP3pYla" e 3G& `eoT#@ *;d $8v + Yu @bAD`K@8m.`:DPeV @l 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. Q. P.O. Explains how to receive, load and send 834 EDI files for member information. A. endstream endobj startxref DOS prior toApril 1, 2021: Processed by WellCare. To avoid rejections please split the services into two separate claim submissions. The Medicare portion of the agreement will continue to function in its entirety as applicable. We have licensed clinicians available to speak with you and to connect you to the support you need to feel better. Earliest From Dates on or after April 1, 2021 should be filed to Absolute Total Care. Medicaid - Wellcare NC Within five business days of getting your grievance, we will mail you a letter. They are called: State law allows you to make a grievance if you have any problems with us. 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. Appeals and Grievances | Wellcare Timely Filing Beginning October 1, 2020, the Timely Filing submission requirements specified in each Provider's Meridian Medicare contract will be enforced. Download the free version of Adobe Reader. How do I determine if an institutional inpatient bill type submission overlapping 4/1/2021 should be filed to WellCare or Absolute Total Care? Select your topic and plan and click "Chat Now!" to chat with a live agent! What is Molina Healthcare timely filing limit? - Short-Question By continuing to use our site, you agree to our Privacy Policy and Terms of Use. Claims - Wellcare NC Professional and Institutional Fee-For-Service EDI transactions should be submitted to WellCare of South Carolina Medicaid with Payer ID 14163. However, there will be no members accessing/assigned to the Medicaid portion of the agreement. A. WellCare credentialing cycles will be shared with Absolute Total Care in order to reduce duplicative credentialing in the future. The Claim Reconsideration process is an informal claim review, and is not a substitute for an appeal of a final agency decision. Q. Claims Department You can get many of your Coronavirus-related questions answered here. How do I bill a professional submission with services spanning before and after 04/01/2021? With the completion of this transaction, we have created a premier healthcare enterprise focused on government-sponsored healthcare programs. WellCare of South Carolina will be known as Absolute Total Care as of April 1, 2021. WellCare of North Carolina will begin to release medical payments to providers beginning July 6, 2021. Examples: If Statement Range is March 14, 2021 through April 3, 2021, please send to WellCare. In South Carolina, WellCare and Absolute Total Care are joining to better serve you. WellCare claims will be processed according to timely filing provisions in the providers WellCare Participating Provider Agreement. Division of Appeals and Hearings You will need Adobe Reader to open PDFs on this site. A. Claim Reconsideration Policy-Fee For Service (FFS) Medicaid Q. Member Sign-In. Learn more about how were supporting members and providers. Timely Filing: A Cheat Sheet for PTs | WebPT For dates of service on or after April 1, 2021: Absolute Total Care Wellcare uses cookies. 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. Timely filing is when you file a claim within a payer-determined time limit. The provider needs to contact Absolute Total Care to arrange continuing care. BlueCross BlueShield of South Carolina Piedmont Service Center P.O. Box 100605 Columbia, SC 29260. The materials located on our website are for dates of service prior to April 1, 2021. If you file a grievance or an appeal, we must be fair. As of April 1, 2021, all WellCare of South Carolina Medicaid members will become Absolute Total Care members. We must have your written permission before someone can file a grievance for you. Box 3050 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 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. As of April 1, 2021, all WellCare of South Carolina Medicaid members will become Absolute Total Care members. This gives members time to establish with a new provider in the network and ensure that they have continuity of care. We comply with applicable Federal civil rights laws and do not discriminate on the basis of race, color, national origin, age, sex, or disability. 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. Absolute Total Care will honor all existing WellCare authorization approvals that include dates of service beyond March 31, 2021. Claims will be processed according to timely filing provisions in the providers Absolute Total Care Participating Provider Agreement. Timely filing limits vary. Copyright 2023 Wellcare Health Plans, Inc. Will my existing WellCare patients be assigned to my Absolute Total Care Panel? If Statement Range is April 2, 2021 through April 10, 2021, please send to Absolute Total Care. Provider Manuals and Forms | Absolute Total Care These SNP plans provide benefits beyond Original Medicare, and may include transportation to medical appointments and vision exams. 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. For standard requests, if you call in your appeal, you must follow up with a written, signed one, within thirty calendar days. All Paper Claim Submissions can be mailed to: WellCare Health Plans English - Wellcare NC Reconsideration or Claim Disputes/Appeals: 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. Timely Filing Limits for all Insurances updated (2023) Earliest From Dates prior to April 1, 2021 should be filed to WellCare of South Carolina. You can get many of your Coronavirus-related questions answered here. It is called a "Notice of Adverse Benefit Determination" or "NABD." WellCare of South Carolina will be known as Absolute Total Care as of April 1, 2021. South Carolina : Login Obstetrician care provided by an out of network Obstetrician will be covered for pregnant members inclusive of post-partum care. If you dont, we will have to deny your request. The rules include what we must do when we get a grievance. 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. Do I need to do anything additional to provide services on or after 4/1/2021 if I am in network with both WellCare and Absolute Total Care? DOSApril 1, 2021 and after: Processed by Absolute Total Care. WellCare has partnered with Change Healthcare as our preferred EDI Clearinghouse. Pharmacy services prior to April 1, 2021 must be requested from WellCare of South Carolina. 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 Call us to get this form. Q. 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. A. WellCare of South Carolina will be known as Absolute Total Care as of April 1, 2021. Welcome to WellCare of South Carolina | Wellcare You or your authorized representative can review the information we used to make our decision. As of April 1, 2021, WellCare will no longer be a separate plan option offered by South Carolina Healthy Connections Choices. 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. The member will be encouraged to establish care with a new in network primary care provider/specialist prior to the end of the transition/continuity of care period to review present treatment plan and coordinate the member's medical care. We cannot disenroll you from our plan or treat you differently. Absolute Total Care will continue to offer Marketplace products under the Ambetter brand. 941w*)bF iLK\c;nF mhk} From Date Institutional Statement Dates on or after April 1, 2021 should be filed to Absolute Total Care. A grievance is when you tell us about a concern you have with our plan. #~0 I Earliest From Dates prior to 4/1/2021 should be filed to WellCare of South Carolina. 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. Explains rules and state, line of business and CMS-specific regulations regarding 837I EDI transactions. %%EOF 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). 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 You can ask for a State Fair Hearing after we make our appeal decision. Columbia, SC 29202-8206. Box 8206 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 will continue to work directly with WellCare to address any claims for dates of service prior to the membership transfer of April 1, 2021. Attn: Grievance Department Box 600601 Columbia, SC 29260. 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. All dates of service on or after April 1, 2021 should be filed to Absolute Total Care. It will tell you we received your grievance. The participating provider agreement with WellCare will remain in-place after April 1, 2021. The second level review will follow the same process and procedure outlined for the initial review. Timely Filing Limit List in Medica Billing (2020 - Medical Billing RCM We want to ensure that claims are handled as efficiently as possible. It will let you know we received your appeal.