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. The onlineProvider Manual represents the most up-to-date information on Absolute Total Cares Medicaid Plan, programs, policies, and procedures. You can ask in writing for a State Fair Hearing (hearing, for short). Box 3050 At WellCare, we value everything you do to deliver quality care to our members your patients and ensure they have a positive health care experience. 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. What will happen to my Participating Provider Agreement with WellCare after 4/1/2021? Wfu neebybfgnh bgWfulnybfgC South Carolina Medicaid Provider Resource Guide Thank you for being a star member of our provider team. DOS prior toApril 1, 2021: Processed by WellCare. Claims for services on or after April 1, 2021 should be filed to Absolute Total Care for processing. The participating provider agreement with WellCare will remain in-place after 4/1/2021. UnitedHealthcare Dual Complete Special Needs Plan UnitedHealthcare Dual Complete Special Needs Plans (SNP) offer benefits for people with both Medicare and Medicaid. Overview & Resources WellCare of North Carolina partners with providers to develop and deliver high-quality, cost-effective health care solutions. Resources Please use the earliest From Date. If an authorization is needed, you can log in to the Secure Provider Portal at absolutetotalcare.com to submit and confirm authorizations. Explains rules and state, line of business and CMS-specific regulations regarding 837P EDI transactions. South Carolina Department of Health and Human Services Division of Appeals and Hearings P.O. As of April 1, 2021, all WellCare of South Carolina Medicaid members will become Absolute Total Care members. WellCare credentialing cycles will be shared with Absolute Total Care in order to reduce duplicative credentialing in the future. A hearing officer from the State will decide if we made the right decision. You may do this in writing or in person. You and the person you choose to represent you must sign the AOR statement. Will WellCare continue to offer current products or Medicare only? Members will receive a 90-day transition of care period if the member is receiving ongoing care and treatment. 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. 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. 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. 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. Q. To avoid rejections please split the services into two separate claim submissions. To do this: Be sure to ask us to continue your benefits within the 10 calendar day time frame. State Health Plan State Claims P.O. Absolute Total Care will honor all existing WellCare authorization approvals that include dates of service beyond March 31, 2021. Beginning. For dates of service on or after April 1, 2021: Absolute Total Care In this section, we will explain how you can tell us about these concerns/grievances. 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. Box 6000 Greenville, SC 29606. Q. Federal Employee Program (FEP) Federal Employee Program P.O. 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. We are committed to improving the quality of life of our millions of members, who often include some of our nations most vulnerable populations. You and the person you choose to represent you must sign the AOR form. WellCare is the health care plan that puts you in control. A grievance is when you tell us about a concern you have with our plan. With the completion of this transaction, we have created a premier healthcare enterprise focused on government-sponsored healthcare programs. Member Sign-In. We are proud to announce that WellCare is now part of the Centene Family. Your second-level review will be performed by person(s) not involved in the first review. Tampa, FL 33631-3372. Effective January 1, 2015 the South Carolina Department of Health and Human Services (SCDHHS) will implement a Claim Reconsideration Policy. Q: What is Absolute Total Cares Transition/Continuity of Care Policy? As of April 1, 2021, all WellCare of South Carolina Medicaid members will become Absolute Total Care members. 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. Professional and Institutional Fee-For-Service EDI transactions should be submitted to WellCare of South Carolina Medicaid with Payer ID 14163. 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. Thanka kaa yoa Tufrbeau ingsnh ngetfu South Caralaita nouMa mpvd. Claims will be processed according to timely filing provisions in the providers Absolute Total Care Participating Provider Agreement. Additionally, WellCare will have a migration section on their provider page at publishing FAQs. You will receive an acknowledgement letter within 5 business days, and we will send you a resolution within 90 calendar days. 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. Download the free version of Adobe Reader. 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. These materials are for informational purposes only. Absolute Total Care will honor all existing WellCare authorization approvals that include dates of service beyond March 31, 2021. Division of Appeals and Hearings 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. Absolute Total Care will continue to offer Marketplace products under the Ambetter brand. 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 must ask within 30 calendar days of getting our decision. Pregnant members receiving care from an out-of-network Obstetrician can continue to see their current obstetrician until after the baby is born. endstream endobj startxref 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. 837 Institutional Encounter 5010v Guide Professional and Institutional Encounter EDI transactions should be submitted to WellCare of South Carolina Medicaid with Payer ID 59354. If you dont, we will have to deny your request. 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. A. We are glad you joined our family! If you file a grievance or an appeal, we must be fair. WellCare of South Carolina will be known as Absolute Total Care as of April 1, 2021. Q. The state has also helped to set the rules for making a grievance. Attn: Grievance Department We welcome Brokers who share our commitment to compliance and member satisfaction. Claim Filing Manual - First Choice by Select Health of South Carolina We have licensed clinicians available to speak with you and to connect you to the support you need to feel better. Farmington, MO 63640-3821. ?-}++lz;.0U(_I]:3O'~3-~%-JM Providers interested in joining the Absolute Total Care Provider Network should submit a request to Network Development and Contracting via email at. We cannot disenroll you from our plan or treat you differently. North Carolina PHP Billing Guidance for Local W Code. If you wish to use a representative, then he or she must complete an Appointment of Representative (AOR) statement. 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. You can file a grievance by calling or writing to us. Absolute Total Care will continue to offer Marketplace products under the Ambetter brand. Wellcare uses cookies. Copyright 2023 Wellcare Health Plans, Inc. We will call you with our decision if we decide you need a fast appeal. This manual sets forth the policies and procedures that providers participating in the Wellcare Prime network are required tofollow. Earliest From Dates prior to 4/1/2021 should be filed to WellCare of South Carolina. The Medicare portion of the agreement will continue to function in its entirety as applicable. Q. Register now. We are simplifying Medicare so you can choose and use an affordable local plan that will help you achieve your best possible health. Wellcare wants to ensure that claims are handled as efficiently as possible. Absolute Total Care will honor those authorizations. 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. Obstetrician care provided by an out of network Obstetrician will be covered for pregnant members inclusive of post-partum care. From time to time, WellCare Health Plans reviews its reimbursement policies to maintain close alignment with industry standards and coding updates released by health care industry sources like the Centers for Medicare and Medicaid Services (CMS), and nationally recognized health and medical societies. The benefit can be used to get more than 150 items - including vitamins, pain relievers, cold and allergy medicines, baby wipes, and diapers - at no cost . Please use the From Date Institutional Statement Date. hb```b``6``e`~ "@1V NB, Members can continue to receive services from their current WellCare provider as long as they remain covered under WellCare. Q. Wellcare uses cookies. 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 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. WellCare and Absolute Total Care Medicare plans will continue to operate under current brands, product names and provider contracts, until further notice. Farmington, MO 63640-3821. The annual flu vaccine helps prevent the flu.Protect yourself and those around you. BlueCross BlueShield of South Carolina Piedmont Service Center P.O. 1,flQ*!WLOmsmz\D;I5BI,yA#z!vYQi5'fedREF40 b666q1(UtUJJ.i` (T/@E 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. The provider needs to contact Absolute Total Care to arrange continuing care. 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. We expect this process to be seamless for our valued members and there will be no break in their coverage. Our call centers, including the nurse advice line, are currently experiencing high volume. From Date Institutional Statement Dates on or after 4/1/2021 should be filed to Absolute Total Care. Outpatient Prior Authorization Form (PDF) Inpatient Prior Authorization Form (PDF) Q. Pregnant members receiving care from an out of network Obstetrician can continue to see their current Obstetrician until after the baby is born. Copyright 2023 Wellcare Health Plans, Inc. April 1-April 3, 2021, please send to Absolute Total Care. P.O. Tampa, FL 33631-3384. Wellcare uses cookies. * Username. S< You can get many of your Coronavirus-related questions answered here. To write us, send mail to: You can fax it too. 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. Earliest From Dates on or after 4/1/2021 should be filed to Absolute Total Care. The rules include what we must do when we get a grievance. As of April 1, 2021, WellCare will no longer be a separate plan option offered by South Carolina Healthy Connections Choices. As of April 1, 2021 Absolute Total Care, a Centene company, is now the health plan for South Carolina Medicaid members. How do I determine if an institutional inpatient bill type submission overlapping 4/1/2021 should be filed to WellCare or Absolute Total Care? Explains rules and state, line of business and CMS-specific regulations regarding 837P EDI transactions. Awagandakami Absolute Total Care People of all ages can be infected. Addakam ditoy para kenka. Columbia, SC 29202-8206. With the completion of this transaction, we have created a premier healthcare enterprise focused on government-sponsored healthcare programs. Claims will be processed according to timely filing provisions in the providers Absolute Total Care Participating Provider Agreement. We may apply a 14 day extension to your grievance resolution. 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). 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 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. The provider needs to contact Absolute Total Care to arrange continuing care. You, your friend, a relative, legal counsel or other spokesperson who has your written consent may ask for a State Fair Hearing. 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. For the latest COVID-19 news, visit the CDC. 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. However, there will be no members accessing/assigned to the Medicaid portion of the agreement. * Password. 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. Claims for services prior to April 1, 2021 should be filed to WellCare for processing. This manual sets forth the policies and procedures that providers participating in the Absolute Total Carenetwork are required tofollow. They are called: State law allows you to make a grievance if you have any problems with us. The second level review will follow the same process and procedure outlined for the initial review. For current information, visit the Absolute Total Care website. 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. Absolute Total Care will honor those authorizations. An authorized representative is someone you select to act on the behalf of a member to assist them through the appeals process. If you request a hearing, the request must: A State Fair Hearing is a legal proceeding. If at any time you need help filing one, call us. All dates of service on or after April 1, 2021 should be filed to Absolute Total Care. Members must have Medicaid to enroll. 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. The Claim Reconsideration process is an informal claim review, and is not a substitute for an appeal of a final agency decision. A. It is called a "Notice of Adverse Benefit Determination" or "NABD." They must inform their vendor of AmeriHealth Caritas . 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. Symptoms are flu-like, including: Fever Coughing 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. A. Register now at https://www.payspanhealth.comor contact PaySpan at providersupport@payspanhealth.com, or 877-331-7154. It was a smart move. It will let you know we received your appeal. Search for primary care providers, hospitals, pharmacies, and more! WellCare understands that having access to the right tools can help you and your staff streamline day-to-day administrative tasks. However, as of April 1, 2021, all WellCare of South Carolina Medicaid members will become Absolute Total Care members. You can file an appeal if you do not agree with our decision. 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. Initial Claims: 120 Days from the Date of Service. 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. DOSApril 1, 2021 and after: Processed by Absolute Total Care. %PDF-1.6 % The materials located on our website are for dates of service prior to April 1, 2021. Know the facts about Coronavirus (COVID-19) Our call centers, including the nurse advice line, are currently experiencing high volume. 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. A. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. A. 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 WellCare of North Carolina partners with providers to develop and deliver high-quality, cost-effective health care solutions. However, as of April 1, 2021, all WellCare of South Carolina Medicaid members will become Absolute Total Care members. 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. Member Appeals (Medical, Behavioral Health, and Pharmacy): You will need Adobe Reader to open PDFs on this site. Refer to your particular provider type program chapter for clarification. Q. 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. Select Health Claims must be filed within 12 months from the date of service. You can make three types of grievances. Box 600601 Columbia, SC 29260. Date of Occurrence/DOSprior toApril 1, 2021: Processed by WellCare. How are WellCare Medicaid member authorizations being handled after April 1, 2021? Wellcare uses cookies. 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. Coronavirus Disease 2019 (COVID-19) causes respiratory illness in people and can spread from person to person. WellCare and Absolute Total Care Medicare plans will continue to operate under current brands, product names and provider contracts, until further notice. Instructions on how to submit a corrected or voided claim. 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. The onlineProvider Manual represents the most up-to-date information on Wellcare Prime by Absolute Total Care (Medicare-Medicaid Plan), programs, policies, and procedures. Get an annual flu shot today. Please Explore the Site and Get To Know Us. L]4(f4/pn~YTZSp-5/O*F)e~p:a6o{x8r 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). Our toll-free fax number is 1-877-297-3112. A. A. South Carolina DEPARTMENT OF HEALTH AND HUMAN SERVICES Post Office Box 8206 Columbia, South Carolina 29202-8206 www.scdhhs.gov November 24, 2009 ALL . Hearings are used when you were denied a service or only part of the service was approved. First Choice can accept claim submissions via paper or electronically (EDI). 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. You must file your appeal within 60 calendar days from the date on the NABD. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. 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. More Information Coronavirus (COVID-19) 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. Explains rules and state, line of business and CMS-specific regulations regarding 837I EDI transactions. This must be done within 120 days from the date of Notice of Appeal Resolution you received from us. Those who attend the hearing include: You can also request to have your hearing over the phone. Contact Wellcare Prime Provider Service at 1-855-735-4398 if you have questions. We will review it and send you a decision letter within 30 calendar days from receiving your appeal. Explains how to receive, load and send 834 EDI files for member information. This gives members time to establish with a new provider in the network and ensure that they have continuity of care. Finding a doctor is quick and easy. What is the Rx BIN and Group Number for WellCare members transitioning to Absolute Total Care on April 1, 2021? Ambetter Timely Filing Limit of : 1) Initial Claims. You or your authorized representative can review the information we used to make our decision. Obstetrician care provided by an out-of-network obstetrician will be covered for pregnant members inclusive of postpartum care. 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.