Instructions on how to submit a corrected or voided claim. Our call centers, including the nurse advice line, are currently experiencing high volume. Coronavirus Disease 2019 (COVID-19) causes respiratory illness in people and can spread from person to person. Earliest From Dates on or after April 1, 2021 should be filed to Absolute Total Care. 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. Earliest From Dates prior to 4/1/2021 should be filed to WellCare of South Carolina. Wellcare uses cookies. You or your authorized representative will tell the hearing officer why you think we made the wrong decision. 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. Explains rules and state, line of business and CMS-specific regulations regarding 837I EDI transactions. With quality healthcare solutions, Ambetter from Absolute Total Care helps residents of South Carolina live better. Providers can help facilitate timely claim payment by having an understanding of our processes and requirements. If an authorization is needed, you can log in to the Secure Provider Portal at absolutetotalcare.com to submit and confirm authorizations. The Medicare portion of the agreement will continue to function in its entirety as applicable. Contact Absolute Total Care Provider Service at1-866-433-6041if youhave questions. An authorized representative is someone you select to act on the behalf of a member to assist them through the appeals process. Claims Department Shop or Enroll in a Plan Frequently Asked Questions Find a Doctor Download Digital ID Card Welcome Allwell Members! BlueCross BlueShield of South Carolina Piedmont Service Center P.O. Date of Occurrence/DOSApril 1, 2021 and after: Processed by Absolute Total Care. 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. Earliest From Dates prior to April 1, 2021 should be filed to WellCare of South Carolina. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. 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. Wfu neebybfgnh bgWfulnybfgC South Carolina Medicaid Provider Resource Guide Thank you for being a star member of our provider team. Q. (This includes your PCP or another provider.) Download the free version of Adobe Reader. z4M0(th`1Lf`M18c BIcJ[%4l JU2 _ s Pharmacy services prior to 4/1/2021 must be requested from WellCare South Carolina. South Carolina DEPARTMENT OF HEALTH AND HUMAN SERVICES Post Office Box 8206 Columbia, South Carolina 29202-8206 www.scdhhs.gov November 24, 2009 ALL . 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 Medicare portion of the agreement will continue to function in its entirety as applicable. You may do this in writing or in person. Member Sign-In. If Statement Range is April 2, 2021 through April 10, 2021, please send to Absolute Total Care. Timely filing is when you file a claim within a payer-determined time limit. Tampa, FL 33631-3372. 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. Claims will be processed according to timely filing provisions in the providers WellCare Participating Provider Agreement. It is called a "Notice of Adverse Benefit Determination" or "NABD." Members can continue to receive services from their current WellCare provider as long as they remain covered under WellCare. 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 Reimbursement Policies From Date Institutional Statement Dates on or after April 1, 2021 should be filed to Absolute Total Care. We are glad you joined our family! Download the free version of Adobe Reader. Instructions on how to submit a corrected or voided claim. 2023 Medicare and PDP Compare Plans and Enroll Now. A. To have someone represent you, you must complete an Appointment of Representative (AOR) form. pst/!+ Y^Ynwb7tw,eI^ By continuing to use our site, you agree to our Privacy Policy and Terms of Use. 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. Please use the Earliest From Date. 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. Additionally, WellCare will have a migration section on their provider page at publishing FAQs. WellCare understands that having access to the right tools can help you and your staff streamline day-to-day administrative tasks. Ambetter from Absolute Total Care - South Carolina. 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. You must file your appeal within 60 calendar days from the date on the NABD. WellCare and Absolute Total Care Medicare plans will continue to operate under current brands, product names and provider contracts, until further notice. A. WellCare Health Plans, Inc. (NYSE: WCG) is now offering a $120 credit per family, per year towards over-the-counter (OTC) items as part of its Medicaid program benefits in South Carolina. The timely filing limit is the time duration from service rendered to patients and submitting claims to the insurance companies. We encourage you to check the Medicaid Pre-Auth Check Tool in the For Providers section on the Absolute Total Care website at absolutetotalcare.com to ensure that you are accessing the most current Absolute Total Care authorization requirements for dates of service on or after 4/1/2021. Go365 for Humana Healthy Horizons Members can register for the new Go365 for Humana Healthy Horizons wellness program and earn rewards for participating in healthy activities. Pregnant members receiving care from an out-of-network Obstetrician can continue to see their current obstetrician until after the baby is born. All transitioning Medicaid members will receive a welcome packet and new ID card from Absolute Total Care in March 2021 and will use the Absolute Total Care ID card to get prescriptions and access healthcare services starting April 1, 2021. The way your providers or others act or treat you. hYnH~}9'I`@>cLq,&DYH"W~&eJx'"luWU]JDBFRJ!*SN(s'6# ^*dg4$SB7K4z:r6')baka+Raf4J=)l, _/jaSpao69&&_Ln=?/{:,'z .1J0|~jv4[eUN{:-gl! K'&hng?y},&X/|OzcJ@0PhDiO})9RA9tG%=|rBhHBz7 Additionally, WellCare will have a migration section on their provider webpage publishing FAQs. 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 claims will be processed according to timely filing provisions in the providers WellCare Participating Provider Agreement. We will continue covering your medical services during your appeal request and State Fair Hearing if all of the following are meet. Q. DOS April 1, 2021 and after: Processed by Absolute Total Care. More Information Coronavirus (COVID-19) WellCare offers participating providers EFT and ERA services at no charge through PaySpan Health. You will receive an acknowledgement letter within 5 business days, and we will send you a resolution within 90 calendar days. The participating provider agreement with WellCare will remain in-place after April 1, 2021. Absolute Total Care will honor all existing WellCare authorization approvals that include dates of service beyond March 31, 2021. Within five business days of getting your grievance, we will mail you a letter. Please use the From Date Institutional Statement Date. This must be done within 120 days from the date of Notice of Appeal Resolution you received from us. Federal Employee Program (FEP) Federal Employee Program P.O. With the completion of this transaction, we have created a premier healthcare enterprise focused on government-sponsored healthcare programs. To write us, send mail to: You can fax it too. Q. All dates of service prior to 4/1/2021 should be filed to WellCare of South Carolina. Continuation of Benefits During the Appeals Process We will continue covering your medical services during your appeal request and State Fair Hearing if all of the following are meet. Get an annual flu shot today. Written notice is not needed if your expedited appeal request is filed verbally. Please be sure to use the correct line of business prior authorization form for prior authorization requests. 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 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. You or your provider must call or fax us to ask for a fast appeal. We are proud to announce that WellCare is now part of the Centene Family. A. A. PROVIDERS NOTE:Please send Corrected Claims as normal submissions via electronic or paper. Will Absolute Total Care continue to offer Medicare and Marketplace products? Please see list of services that will require authorization during this time. For dates of service prior to April 1, 2021: All paper claim submissions can be mailed to: WellCare Health Plans WellCare Medicaid members migrating to Absolute Total Care will be assigned to their assigned WellCare primary care provider as if the primary care provideris in network with Absolute Total Care. What will happen to unresolved claims prior to the membership transfer? 3) Coordination of Benefits. How do I determine if a professional or an outpatient bill type institutional submission should be filed to WellCare or Absolute Total Care? By continuing to use our site, you agree to our Privacy Policy and Terms of Use. The onlineProvider Manual represents the most up-to-date information on Wellcare Prime by Absolute Total Care (Medicare-Medicaid Plan), programs, policies, and procedures. Members must have Medicaid to enroll. 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. Provider can't require members to appoint them as a condition of getting services. You must ask within 30 calendar days of getting our decision. The provider needs to contact Absolute Total Care to arrange continuing care. To do this: How do I determine if an institutional inpatient bill type submission overlapping 4/1/2021 should be filed to WellCare or Absolute Total Care? Q. A. Pharmacy services prior to April 1, 2021 must be requested from WellCare of South Carolina. We will do this as quickly as possible as but no longer than 72-hours from the decision. Member Appeals (Medical, Behavioral Health, and Pharmacy): You will need Adobe Reader to open PDFs on this site. A. 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? This gives members time to establish with a new provider in the network and ensure that they have continuity of care. You can file an appeal if you do not agree with our decision. Or you can have someone file it for you. 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. 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. Check out the Interoperability Page to learn more. A. North Carolina PHP Billing Guidance for Local W Code. Providers interested in joining the Absolute Total Care Provider Network should submit a request to Network Development and Contracting via email at. Claims Department How will credentialing/recredentialing be handled by Absolute Total Care if a provider was recently credentialed/recredentialed by WellCare? Payments mailed to providers are subject to USPS mailing timeframes. Box 600601 Columbia, SC 29260. Q. It will let you know we received your appeal. Claims will be processed according to timely filing provisions in the providers Absolute Total Care Participating Provider Agreement. 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 State Health Plan State Claims P.O. Will WellCare continue to offer current products or Medicare only? We are simplifying Medicare so you can choose and use an affordable local plan that will help you achieve your best possible health. Awagandakami Welcome to Wellcare By Allwell, a Medicare Advantage plan. Your second-level review will be performed by person(s) not involved in the first review. 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. If at any time you need help filing one, call us. Please use WellCare Payor ID 14163. 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?