Please use WellCare Payor ID 14163. Absolute Total Care will continue to offer Marketplace products under the Ambetter brand. Want to receive your payments faster to improve cash flow? We would like to help your billing department get your EDI (claims and real time) transactions processed as efficiently as possible. You can get many of your Coronavirus-related questions answered here. We will do this as quickly as possible as but no longer than 72-hours from the decision. March 14-March 31, 2021, please send to WellCare. Overview & Resources WellCare of North Carolina partners with providers to develop and deliver high-quality, cost-effective health care solutions. Explains how to receive, load and send 834 EDI files for member information. endstream endobj startxref The way your providers or others act or treat you. The Claim Reconsideration process is an informal claim review, and is not a substitute for an appeal of a final agency decision. The provider needs to contact Absolute Total Care to arrange continuing care. Additionally, WellCare will have a migration section on their provider page at publishing FAQs. Or you can have someone file it for you. A. Contact Us Y0020_WCM_100876E Last Updated On: 10/1/2022 Q. P.O. The Medicare portion of the agreement will continue to function in its entirety as applicable. Q. We are glad you joined our family! Wellcare wants to ensure that claims are handled as efficiently as possible. Claim Filing Manual - First Choice by Select Health of South Carolina It is called a "Notice of Adverse Benefit Determination" or "NABD." You or your authorized representative will tell the hearing officer why you think we made the wrong decision. Division of Appeals and Hearings P.O. 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. Our health insurance programs are committed to transforming the health of the community one individual at a time. 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. Will Absolute Total Care continue to offer Medicare and Marketplace products? To avoid rejections please split the services into two separate claim submissions. pst/!+ Y^Ynwb7tw,eI^ A. What will happen to my Participating Provider Agreement with WellCare after 4/1/2021? 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. To have someone represent you, you must complete an Appointment of Representative (AOR) form. Outpatient Prior Authorization Form (PDF) Inpatient Prior Authorization Form (PDF) All billing requirements must be adher ed to by the provider in order to ensure timely processing of claims. Finding a doctor is quick and easy. Symptoms are flu-like, including: Fever Coughing 8h} \x p`03 1z`@+`~70 G ~Ws5Puick79,4 ,O5@?O-Gr'|5Oj:v6/` We will send you another letter with our decision within 90 days or sooner. WellCare understands that having access to the right tools can help you and your staff streamline day-to-day administrative tasks. Guides Filing Claims with WellCare. Box 31224 Q. WellCare Medicare members are not affected by this change. 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! ?-}++lz;.0U(_I]:3O'~3-~%-JM 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. 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. Those who attend the hearing include: You can also request to have your hearing over the phone. They are called: State law allows you to make a grievance if you have any problems with us. Only you or your authorizedrepresentative can ask for a State Fair Hearing. To do so by phone, call Member Services at 1-888-588-9842 (TTY1-877-247-6272). With the completion of this transaction, we have created a premier healthcare enterprise focused on government-sponsored healthcare programs. 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. The state has also helped to set the rules for making a grievance. WellCare Health Plans, Inc. (NYSE: WCG) is now offering a $120 credit per family, per year towards over-the-counter (OTC) items as part of its Medicaid program benefits in South Carolina. A. You or your provider must call or fax us to ask for a fast appeal. From time to time, WellCare Health Plans reviews its reimbursement policies to maintain close alignment with industry standards and coding updates released by health care industry sources like the Centers for Medicare and Medicaid Services (CMS), and nationally recognized health and medical societies. N .7$* P!70 *I;Rox3 ] LS~. 2023 Medicare and PDP Compare Plans and Enroll Now. We will also send you a letter with our decision within 72 hours from receiving your appeal. For standard requests, if you call in your appeal, you must follow up with a written, signed one, within thirty calendar days. State Health Plan State Claims P.O. It is 30 days to 1 year and more and depends on . Q. A. More Information Need help? Wellcare uses cookies. Select your topic and plan and click "Chat Now!" to chat with a live agent! L]4(f4/pn~YTZSp-5/O*F)e~p:a6o{x8r 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. To avoid rejections please split the services into two separate claim submissions. 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. We are committed to improving the quality of life of our millions of members, who often include some of our nations most vulnerable populations. 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. 3) Coordination of Benefits. Member Appeals (Medical, Behavioral Health, and Pharmacy): Copyright 2023 Wellcare Health Plans, Inc. As of April 1, 2021, all WellCare of South Carolina Medicaid members will become Absolute Total Care members. Shop or Enroll in a Plan Frequently Asked Questions Find a Doctor Download Digital ID Card Welcome Allwell Members! The member will be encouraged to establish care with a new in network PCP/specialist prior to the end of the transition/continuity of care period to review present treatment plan and coordinate the member's medical care. Q: What is Absolute Total Cares Transition/Continuity of Care Policy? Please use the Earliest From Date. 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. We understand that maintaining a healthy community starts with providing care to those who need it most. 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. Keep yourself informed about Coronavirus (COVID-19.) Molina Healthcare of Michigan, 100 W. Big Beaver Road, Suite 600 Attn: Claims, Troy, MI 48084-5209 Or Fax to: (248) 925-1768. 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. There is a lot of insurance that follows different time frames for claim submission. Members will need to talk to their provider right away if they want to keep seeing him/her. Attn: Grievance Department Register now at https://www.payspanhealth.comor contact PaySpan at providersupport@payspanhealth.com, or 877-331-7154. 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 general questions about claims submissions, call Provider Claims Services at 1-800-575-0418. If you are unable to view PDFs, please download Adobe Reader. 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). We must have your written permission before someone can file a grievance for you. If an authorization is needed, you can log in to the Secure Provider Portal at absolutetotalcare.com to submit and confirm authorizations. An appeal may be filed within 60 calendar days from the date on the Adverse Benefit Determination Notice. From Date Institutional Statement Dates on or after April 1, 2021 should be filed to Absolute Total Care. From Date Institutional Statement Dates prior to April 1, 2021 should be filed to WellCare of South Carolina. 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. You and the person you choose to represent you must sign the AOR form. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. Forms. A. 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. WellCare of South Carolina will be known as Absolute Total Care as of April 1, 2021. A hearing officer from the State will decide if we made the right decision. We are simplifying Medicare so you can choose and use an affordable local plan that will help you achieve your best possible health. South Carolina | Wellcare SOUTH CAROLINA Healthcare done well. We will continue covering your medical services during your appeal request and State Fair Hearing if all of the following are meet. We expect this process to be seamless for our valued members, and there will be no break in their coverage. A. Will Absolute Total Care change its name to WellCare? A. you have another option. This manual sets forth the policies and procedures that providers participating in the Absolute Total Carenetwork are required tofollow. Q. All dates of service on or after 4/1/2021 should be filed to Absolute Total Care. Q. Our fax number is 1-866-201-0657. 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. Initial Claims: 120 Days from the Date of Service. However, there will be no members accessing/assigned to the Medicaid portion of the agreement. How do I bill a professional submission with services spanning before and after 04/01/2021? P.O. Explains rules and state, line of business and CMS-specific regulations regarding 837I EDI transactions. All dates of service prior to April 1, 2021 should be filed to WellCare of South Carolina. 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. Claims Department Get an annual flu shot today. 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. A grievance is when you tell us about a concern you have with our plan. To write us, send mail to: You can fax it too. 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 April 1, 2021. Earliest From Dates on or after 4/1/2021 should be filed to Absolute Total Care. You can file an appeal if you do not agree with our decision. DOS prior to April 1, 2021: Processed by WellCare. Tampa, FL 33631-3372. At the hearing, well explain why we made our decision. You may request a State Fair Hearing at this address: South Carolina Department of Health Call us to get this form. Ancillary Claims Filing Reminders; ClaimsXten TM: Correct Coding Initiative Reference Guide; Inpatient Non-Reimbursable Charges/Unbundling Policy WellCare Medicare Advantage Claims must be filed within 180 calendar days from the date of service. Claims will be processed according to timely filing provisions in the providers Absolute Total Care Participating Provider Agreement. hbbd``b`$= $ WellCare of South Carolina will be known as Absolute Total Care as of April 1, 2021. The participating provider agreement with WellCare will remain in-place after April 1, 2021. A. People of all ages can be infected. From Date Institutional Statement Dates prior to 4/1/2021 should be filed to WellCare of South Carolina. They must inform their vendor of AmeriHealth Caritas . To do this: Be sure to ask us to continue your benefits within the 10 calendar day time frame. What will happen to unresolved claims prior to the membership transfer? All Paper Claim Submissions can be mailed to: WellCare Health Plans Additionally, WellCare will have a migration section on their provider page at publishing FAQs. Awagandakami This must be done within 120 days from the date of Notice of Appeal Resolution you received from us. 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. You may do this in writing or in person. Q. We comply with applicable Federal civil rights laws and do not discriminate on the basis of race, color, national origin, age, sex, or disability. Timely filing limits vary. If you request a hearing, the request must: A State Fair Hearing is a legal proceeding. Hearings are used when you were denied a service or only part of the service was approved. As of April 1, 2021, all WellCare of South Carolina Medicaid members will transfer to Absolute Total Care. Please make sure you ask your members for a copy of their Absolute Total Care and Healthy Connections Choices Medicaid ID cards before each visit. We will notify you orally and in writing. 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. A. Claims for services on or after April 1, 2021 should be filed to Absolute Total Care for processing. 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. Absolute Total Care will honor all existing WellCare authorization approvals that include dates of service beyond March 31, 2021. Explains rules and state, line of business and CMS-specific regulations regarding 837P EDI transactions. 0 With the completion of this transaction, we have created a premier healthcare enterprise focused on government-sponsored healthcare programs. Copyright 2023 Wellcare Health Plans, Inc. Clinical Laboratory Improvement Amendments (CLIA).

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