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If Statement Range is April 2, 2021 through April 10, 2021, please send to Absolute Total Care. 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. Examples: If Statement Range is March 14, 2021 through April 3, 2021, please send to WellCare. Kasapulam ti tulong? Symptoms are flu-like, including: Fever Coughing As of April 1, 2021, WellCare will no longer be a separate plan option offered by South Carolina Healthy Connections Choices. 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. Box 3050 Box 8206 Members will receive a 90-day transition of care period if the member is receiving ongoing care and treatment. 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. 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. Will Absolute Total Care continue to offer Medicare and Marketplace products? Exceptions to the one-year time limit: a) Medicare Cost Sharing Claims . 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. Timely Filing Beginning October 1, 2020, the Timely Filing submission requirements specified in each Provider's Meridian Medicare contract will be enforced. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. You can also have a video visit with a doctor using your phone or computer. WellCare Medicare members are not affected by this change. Pregnant members receiving care from an out of network Obstetrician can continue to see their current Obstetrician until after the baby is born. We are simplifying Medicare so you can choose and use an affordable local plan that will help you achieve your best possible health. We try to make filing claims with us as easy as possible. Ancillary Claims Filing Reminders; ClaimsXten TM: Correct Coding Initiative Reference Guide; Inpatient Non-Reimbursable Charges/Unbundling Policy The onlineProvider Manual represents the most up-to-date information on Absolute Total Cares Medicaid Plan, programs, policies, and procedures. Our call centers, including the nurse advice line, are currently experiencing high volume. 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. We are proud to announce that WellCare is now part of the Centene Family. A. A. You can do this at any time during your appeal. A. This manual sets forth the policies and procedures that providers participating in the Absolute Total Carenetwork are required tofollow. For dates of service prior to April 1, 2021: All paper claim submissions can be mailed to: WellCare Health Plans Check out the Interoperability Page to learn more. More Information Coronavirus (COVID-19) Please use the From Date Institutional Statement Date. Explains rules and state, line of business and CMS-specific regulations regarding 837I EDI transactions. A. Section 1: General Information. Earliest From Dates on or after 4/1/2021 should be filed to Absolute Total Care. With the completion of this transaction, we have created a premier healthcare enterprise focused on government-sponsored healthcare programs. Timely filing limits vary. 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. The Claim Reconsideration process is an informal claim review, and is not a substitute for an appeal of a final agency decision. The onlineProvider Manual represents the most up-to-date information on Wellcare Prime by Absolute Total Care (Medicare-Medicaid Plan), programs, policies, and procedures. To do this: 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 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. From Date Institutional Statement Dates on or after April 1, 2021 should be filed to Absolute Total Care. WellCare has partnered with Change Healthcare as our preferred EDI Clearinghouse. #~0 I Q. As of April 1, 2021 Absolute Total Care, a Centene company, is now the health plan for South Carolina Medicaid members. The provider needs to contact Absolute Total Care to arrange continuing 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. 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. All dates of service on or after April 1, 2021 should be filed to Absolute Total Care. 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. Providers interested in joining the Absolute Total Care vision network for routine vision services can contact Envolve Vision at 1-800-531-2818. Date of Occurrence/DOSprior toApril 1, 2021: Processed by WellCare. However, there will be no members accessing/assigned to the Medicaid portion of the agreement. Always verify timely filing requirements with the third party payor. Earliest From Dates prior to April 1, 2021 should be filed to WellCare of South Carolina. All Paper Claim Submissions can be mailed to: WellCare Health Plans P.O. Awagandakami 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. Providers are encouraged to visit the Provider Resources webpagefor manuals, forms, and resources related to claims submission, eligibility, prior authorization, and more. Members will need to talk to their provider right away if they want to keep seeing him/her. We welcome Brokers who share our commitment to compliance and member satisfaction. The Medicare portion of the agreement will continue to function in its entirety as applicable. Claims Department To do so by phone, call Member Services at 1-888-588-9842 (TTY1-877-247-6272). Payments mailed to providers are subject to USPS mailing timeframes. P.O. South Carolina Department of Health and Human Services Division of Appeals and Hearings P.O. L]4(f4/pn~YTZSp-5/O*F)e~p:a6o{x8r hbbd``b`$= $ For standard requests, if you call in your appeal, you must follow up with a written, signed one, within thirty calendar days. Where should I submit claims for WellCare Medicaid members that transition to Absolute Total Care? However, as of April 1, 2021, all WellCare of South Carolina Medicaid members will become Absolute Total Care members. If Statement Range is March 14, 2021 through April 3, 2021, please send to WellCare. 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! 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 From Date Institutional Statement Dates prior to 4/1/2021 should be filed to WellCare of South Carolina. Hearings are used when you were denied a service or only part of the service was approved. 1,flQ*!WLOmsmz\D;I5BI,yA#z!vYQi5'fedREF40 b666q1(UtUJJ.i` (T/@E In South Carolina, WellCare and Absolute Total Care are joining to better serve you. If you request a hearing, the request must: A State Fair Hearing is a legal proceeding. A grievance is when you tell us about a concern you have with our plan. The state has also helped to set the rules for making a grievance. Please use the From Date Institutional Statement Date. 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? Welcome to WellCare of South Carolina! Earliest From Dates prior to 4/1/2021 should be filed to WellCare of South Carolina. N .7$* P!70 *I;Rox3 ] LS~. 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. The hearing officer does not decide in your favor. If Statement Range is April 2, 2021 through April 10, 2021, please send to Absolute Total Care. WellCare claims will be processed according to timely filing provisions in the providers WellCare Participating Provider Agreement. We will notify you orally and in writing. Our health insurance programs are committed to transforming the health of the community one individual at a time. WellCare understands that having access to the right tools can help you and your staff streamline day-to-day administrative tasks. We will call you with our decision if we decide you need a fast appeal. 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. This gives members time to establish with a new provider in the network and ensure that they have continuity of care. Reimbursement Policies you have another option. Q. If you need claim filing assistance, please contact your provider advocate. 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. Go365 for Humana Healthy Horizons Members can register for the new Go365 for Humana Healthy Horizons wellness program and earn rewards for participating in healthy activities. Please use the Earliest From Date. 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. 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. WellCare of South Carolina will be known as Absolute Total Care as of April 1, 2021. We will send you another letter with our decision within 90 days or sooner. 837 Institutional Encounter 5010v Guide Timely filing is when you file a claim within a payer-determined time limit. Please use the earliest From Date. Columbia, SC 29202-8206. People of all ages can be infected. 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. You can get many of your Coronavirus-related questions answered here. Q. Box 31384 Box 6000 Greenville, SC 29606. Absolute Total Care will honor those authorizations. Box 600601 Columbia, SC 29260. WellCare claims will be processed according to timely filing provisions in the providers WellCare Participating Provider Agreement. There is a lot of insurance that follows different time frames for claim submission. A. Keep yourself informed about Coronavirus (COVID-19.) However, as of April 1, 2021, all WellCare of South Carolina Medicaid members will become Absolute Total Care members. We will do this as quickly as possible as but no longer than 72-hours from the 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. You and the person you choose to represent you must sign the AOR form. We expect this process to be seamless for our valued members, and there will be no break in their coverage. Provider can't require members to appoint them as a condition of getting services. pst/!+ Y^Ynwb7tw,eI^ However, there will be no members accessing/assigned to the Medicaid portion of the agreement. Box 31224 Instructions on how to submit a corrected or voided claim. 1096 0 obj <>stream A. An authorized representative is someone you select to act on the behalf of a member to assist them through the appeals process. As of April 1, 2021, all WellCare of South Carolina Medicaid members will become Absolute Total Care members. Claims Submission, Correspondence and Contact Resources will stay the same for the Medicare line of business. Please make sure you ask your members for a copy of their Absolute Total Care and Healthy Connections Choices Medicaid ID cards before each visit. We are glad you joined our family! 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. $8v + Yu @bAD`K@8m.`:DPeV @l If you need assistance with your appeal please call Absolute Total Care at 1-866-433-6041 (TTY: 711) and we will assist you in filing your appeal. Can I continue to see my current WellCare members? UnitedHealthcare Dual Complete Special Needs Plan UnitedHealthcare Dual Complete Special Needs Plans (SNP) offer benefits for people with both Medicare and Medicaid. Learn more about how were supporting members and providers. 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? You will need Adobe Reader to open PDFs on this site. To do so by phone, call Member Services at 1-888-588-9842 (TTY1-877-247-6272). 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. 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. Download the free version of Adobe Reader. 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. With quality healthcare solutions, Ambetter from Absolute Total Care helps residents of South Carolina live better. Download the free version of Adobe Reader. Obstetrician care provided by an out-of-network obstetrician will be covered for pregnant members inclusive of postpartum care. 2023 Medicare and PDP Compare Plans and Enroll Now. Please be sure to use the correct line of business prior authorization form for prior authorization requests. Professional and Institutional Fee-For-Service EDI transactions should be submitted to WellCare of South Carolina Medicaid with Payer ID 14163. Wellcare uses cookies. Outpatient Prior Authorization Form (PDF) Inpatient Prior Authorization Form (PDF) We expect this process to be seamless for our valued members and there will be no break in their coverage. DOSApril 1, 2021 and after: Processed by Absolute Total Care. The Medicare portion of the agreement will continue to function in its entirety as applicable. First Choice can accept claim submissions via paper or electronically (EDI). Within five business days of getting your grievance, we will mail you a letter. If you wish to use a representative, then he or she must complete an Appointment of Representative (AOR) statement. Absolute Total Care will honor those authorizations. 2) Reconsideration or Claim disputes/Appeals. Please contact our Provider Services Call Center at 1-888-898-7969. State Health Plan State Claims P.O. 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. 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. P.O. 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). To avoid rejections please split the services into two separate claim submissions. Or it can be made if we take too long to make a care decision. For general questions about claims submissions, call Provider Claims Services at 1-800-575-0418. Q. This person has all beneficiary rights and responsibilities during the appeal process. Claims for services prior to April 1, 2021 should be filed to WellCare for processing. 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. Payments mailed to providers are subject to USPS mailing timeframes. We're here for you. Overview & Resources WellCare of North Carolina partners with providers to develop and deliver high-quality, cost-effective health care solutions. As of April 1, 2021, all WellCare of South Carolina Medicaid members will transfer to Absolute Total Care. These materials are for informational purposes only. 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. The materials located on our website are for dates of service prior to April 1, 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. Ambetter from Absolute Total Care - South Carolina. WellCare of South Carolina will be known as Absolute Total Care as of April 1, 2021. Here are some guides we created to help you with claims filing. 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. For additional information, questions or concerns, please contact your local Provider Network Management Representative. Will my existing WellCare patients be assigned to my Absolute Total Care Panel? It was a smart move. Member Sign-In. 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. Members can continue to receive services from their current WellCare provider as long as they remain covered under WellCare. WellCare of South Carolinawants to ensure that claims are handled as efficiently as possible. Q. What will happen to my Participating Provider Agreement with WellCare after 4/1/2021? You can ask in writing for a State Fair Hearing (hearing, for short). hb```b``6``e`~ "@1V NB, Send your written appeal to: We must have your written consent before someone can file an appeal for you. %PDF-1.6 % To avoid rejections please split the services into two separate claim submissions. Initial Claims: 120 Days from the Date of Service. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. Providers interested in joining the Absolute Total Care provider network should submit a request to the Network Development and Contracting Department via email at atc_contracting@centene.com. Stay informed - activate your online account Behavioral Health Crisis Line 844-594-5076 (TTY 711) 24 hours a day, seven days a week Call us if you are experiencing emotional or mental pain or distress. Forgot Your Password? Effective January 1, 2015 the South Carolina Department of Health and Human Services (SCDHHS) will implement a Claim Reconsideration Policy. Absolute Total Care will continue to offer Marketplace products under the Ambetter brand. Wellcare uses cookies. 0 Explains how to receive, load and send 834 EDI files for member information. In this section, we will explain how you can tell us about these concerns/grievances. If you dont, we will have to deny your request. 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. Q. You or your authorized representative will tell the hearing officer why you think we made the wrong decision. How do I bill a professional submission with services spanning before and after 04/01/2021? 1044 0 obj <> endobj 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. Get an annual flu shot today. All billing requirements must be adher ed to by the provider in order to ensure timely processing of claims. Contact Absolute Total Care Provider Service at1-866-433-6041if youhave questions. Q. 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. Absolute Total Care will continue to offer Marketplace products under the Ambetter brand. 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. A. An appeal may be filed within 60 calendar days from the date on the Adverse Benefit Determination Notice. Wellcare uses cookies. Electronic and Paper Claims Submissions; Institutional Claims/Encounter Guides. 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 . The participating provider agreement with WellCare will remain in-place after 4/1/2021. WellCare is the health care plan that puts you in control. You must file your appeal within 60 calendar days from the date on the NABD. Only you or your authorizedrepresentative can ask for a State Fair Hearing. * Password. 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. A. Absolute Total Care will honor all existing WellCare authorization approvals that include dates of service beyond March 31, 2021. 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. B^E{h#XYQv;[ny3Hha1yx4v.sBy jWacQzyL.kHhwtQ~35!Rh#)p+sj31LcC)4*Z:IWIG@WTD- )n,! Providers interested in joining the Absolute Total Care Provider Network should submit a request to Network Development and Contracting via email at. The participating provider agreement with WellCare will remain in-place after 4/1/2021. Box 31224 You now have access to a secure, quick way to electronically settle claims. Explains how to receive, load and send 834 EDI files for member information. Claims for services prior to April 1, 2021 should be filed to WellCare for processing.