Q. How do I determine if a professional or an outpatient bill type institutional submission should be filed to WellCare or Absolute Total Care? From Date Institutional Statement Dates prior to 4/1/2021 should be filed to WellCare of South Carolina. The annual flu vaccine helps prevent the flu. Ambetter from Absolute Total Care - South Carolina. You can do this at any time during your appeal. Box 8206 We will send you another letter with our decision within 90 days or sooner. Timely filing is when you file a claim within a payer-determined time limit. You will get a letter from us when any of these actions occur. Forgot Your Password? 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. Wellcare uses cookies. 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. The hearing officer will decide whether our decision was right or wrong. Hearings are used when you were denied a service or only part of the service was approved. Keep yourself informed about Coronavirus (COVID-19.) All dates of service on or after 4/1/2021 should be filed to Absolute Total Care. P.O. An appeal may be filed within 60 calendar days from the date on the Adverse Benefit Determination Notice. You can get many of your Coronavirus-related questions answered here. Payments mailed to providers are subject to USPS mailing timeframes. 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. A. This gives members time to establish with a new provider in the network and ensure that they have continuity of care. Copyright 2023 Wellcare Health Plans, Inc. You will have a limited time to submit additional information for a fast appeal. Members can continue to receive services from their current WellCare provider as long as they remain covered under WellCare. If an authorization is needed, you can log in to the Secure Provider Portalto submit and confirm authorizations. Earliest From Dates on or after 4/1/2021 should be filed to Absolute Total Care. WellCare of South Carolina will be known as Absolute Total Care as of April 1, 2021. APPEALS, GRIEVANCES AND PROVIDER DISPUTES. Welcome to WellCare of South Carolina! 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. That's why we provide tools and resources to help. Download the free version of Adobe Reader. 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. * Password. Absolute Total Care will honor those authorizations. z4M0(th`1Lf`M18c BIcJ[%4l JU2 _ s 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 This gives members time to establish with a new provider in the network and ensure that they have continuity of care. Register now at https://www.payspanhealth.com or contact PaySpan at providersupport@payspanhealth.com, or 877-331-7154. Refer to your particular provider type program chapter for clarification. Absolute Total Care will honor those authorizations. If at any time you need help filing one, call us. What will happen to my Participating Provider Agreement with WellCare after 4/1/2021? Date of Occurrence/DOSprior toApril 1, 2021: Processed by WellCare. 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. 2023 Medicare and PDP Compare Plans and Enroll Now. P.O. From Date Institutional Statement Dates on or after 4/1/2021 should be filed to Absolute Total Care. P.O. 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. 0 We will call you with our decision if we decide you need a fast appeal. Explains rules and state, line of business and CMS-specific regulations regarding 837P EDI transactions. The materials located on our website are for dates of service prior to April 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. Overview & Resources WellCare of North Carolina partners with providers to develop and deliver high-quality, cost-effective health care solutions. You can file an appeal if you do not agree with our decision. 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. If you request a hearing, the request must: A State Fair Hearing is a legal proceeding. Q. Ancillary Claims Filing Reminders; ClaimsXten TM: Correct Coding Initiative Reference Guide; Inpatient Non-Reimbursable Charges/Unbundling Policy 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. 1044 0 obj <> endobj The participating provider agreement with WellCare will remain in-place after 4/1/2021. Timely filing limits vary. If Statement Range is April 2, 2021 through April 10, 2021, please send to Absolute Total Care. Timely Filing Limit: Timely Filing Limit is the time frame set by insurance companies and provider has to submit health care claims to respective insurance company within the set time frame for reimbursement of the claims. Will WellCare continue to offer current products or Medicare only? Q. Our health insurance programs are committed to transforming the health of the community one individual at a time. 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. DOS April 1, 2021 and after: Processed by Absolute Total Care. Q. 2023 Medicare and PDP Compare Plans and Enroll Now Notice of Non-Discrimination We comply with applicable Federal civil rights laws and do not discriminate on the basis of race, color, national origin, age, sex, or disability. Explains rules and state, line of business and CMS-specific regulations regarding 837P EDI transactions. 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. We will also send you a letter with our decision within 72 hours from receiving your appeal. 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 B^E{h#XYQv;[ny3Hha1yx4v.sBy jWacQzyL.kHhwtQ~35!Rh#)p+sj31LcC)4*Z:IWIG@WTD- )n,! 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. Guides Filing Claims with WellCare. Please use the earliest From Date. A. They must inform their vendor of AmeriHealth Caritas . pst/!+ Y^Ynwb7tw,eI^ 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. If Statement Range is March 14, 2021 through April 3, 2021, please send to WellCare. Q. Providers are encouraged to visit the Provider Resources webpagefor manuals, forms, and resources related to claims submission, eligibility, prior authorization, and more. These SNP plans provide benefits beyond Original Medicare, and may include transportation to medical appointments and vision exams. Finding a doctor is quick and easy. WellCare of South Carolina will be known as Absolute Total Care as of April 1, 2021. State Health Plan State Claims P.O. WellCare of South Carolina will be known as Absolute Total Care as of 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. A. Claims Department Pharmacy services prior to 4/1/2021 must be requested from WellCare South Carolina. 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. DOSApril 1, 2021 and after: Processed by Absolute Total Care. 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 encourage you to check the Medicaid Pre-Auth Check Tool in the For Providers section on the Absolute Total Care website at absolutetotalcare.com to ensure that you are accessing the most current Absolute Total Care authorization requirements for dates of service on or after 4/1/2021. We want to ensure that claims are handled as efficiently as possible. Wellcare uses cookies. 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. As of April 1, 2021, WellCare will no longer be a separate plan option offered by South Carolina Healthy Connections Choices. To do so by phone, call Member Services at 1-888-588-9842 (TTY1-877-247-6272). Members will receive a 90-day transition of care period if the member is receiving ongoing care and treatment. A hearing officer from the State will decide if we made the right decision. You can file a grievance by calling or writing to us. With the completion of this transaction, we have created a premier healthcare enterprise focused on government-sponsored healthcare programs. Additionally, WellCare will have a migration section on their provider webpage publishing FAQs. Please use WellCare Payor ID 14163. We cannot disenroll you from our plan or treat you differently. 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. Q. Examples: If Statement Range is March 14, 2021 through April 3, 2021, please send to WellCare. You or your provider must call or fax us to ask for a fast appeal. WellCare claims will be processed according to timely filing provisions in the providers WellCare Participating Provider Agreement. Claims for services on or after April 1, 2021 should be filed to Absolute Total Care for processing. Explains how to receive, load and send 834 EDI files for member information. Awagandakami These materials are for informational purposes only. As of April 1, 2021, WellCare will no longer be a separate plan option offered by South Carolina Healthy Connections Choices. Claims will be processed according to timely filing provisions in the providers Absolute Total Care Participating Provider Agreement. Wellcare uses cookies. Additionally, WellCare will have a migration section on their provider page at publishing FAQs. Download the free version of Adobe Reader. All dates of service on or after April 1, 2021 should be filed to Absolute Total Care. 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. 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. We will notify you orally and in writing. All billing requirements must be adher ed to by the provider in order to ensure timely processing of claims. The onlineProvider Manual represents the most up-to-date information on Absolute Total Cares Medicaid Plan, programs, policies, and procedures. You now have access to a secure, quick way to electronically settle claims. 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. Box 3050 Select your topic and plan and click "Chat Now!" to chat with a live agent! Example of how to properly split claim that span the cutover date of April 1, 2021: Yes, Absolute Total Care and WellCare will continue to offer Medicare products under their current brands and product names, until further notice. WellCare offers participating providers EFT and ERA services at no charge through PaySpan Health. Date of Occurrence/DOSApril 1, 2021 and after: Processed by Absolute Total Care. 941w*)bF iLK\c;nF mhk} Forms. Professional and Institutional Encounter EDI transactions should be submitted to WellCare of South Carolina Medicaid with Payer ID 59354. A. Visit https://msp.scdhhs.gov/appeals/ to: Copyright 2023 Wellcare Health Plans, Inc. https://msp.scdhhs.gov/appeals/site-page/file-appeal, If we deny or limit a service you or your doctor asks us to approve, If we reduce, suspend or stop services youve been getting that we already approved, If we do not pay for the health care services you get, If we fail to give services in the required timeframe, If we fail to give you a decision in the required timeframe on an appeal you already filed, If we dont agree to let you see a doctor who is not in our network and you live in a rural area or in an area with limited doctors, If you dont agree with a decision we made regarding your medicine, We denied your request to dispute a financial liability, The member did not personally receive the notice of action or received the notice late, The member was seriously ill, which prevented a timely appeal, There was a death or serious illness in the members immediate family, An accident caused important records to be destroyed, Documentation was difficult to locate within the time limits; and/or the member had incorrect or incomplete information concerning the appeals process, Change the appeal to the timeframe for a standard decision (30 calendar days), Follow up with a written letter within 2 calendar days, Tell you over the phone and in writing that you may file a grievance about the denial of the fast appeal request, Be in writing and specify the reason for the request, Include your name, address and phone number, Indicate the date of service or the type of service denied, Your authorized representative (if youve chosen one), A hearing officer from Medicaid and Long-Term Care (MLTC), You or your authorized representative with your written consent must file your appeal with us and ask to continue your benefits within 10 calendar days after we mail the Notice of Adverse benefit determination; or, Within 10 calendar days of the intended effective date of the plans proposed action, whichever is later, The appeal or hearing must address the reduction, suspension or stopping of a previously authorized service, The services were ordered by an authorized provider, The period covered by the original authorization cannot have ended.

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