If you think you might have been exposed, contact a doctor immediately. Tampa, FL 33631-3384. This gives members time to establish with a new provider in the network and ensure that they have continuity of care. Member Sign-In. Q. 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. WellCare offers participating providers EFT and ERA services at no charge through PaySpan Health. All dates of service on or after 4/1/2021 should be filed to Absolute Total Care. Please use the From Date Institutional Statement Date. The Medicare portion of the agreement will continue to function in its entirety as applicable. Q. Providers interested in joining the Absolute Total Care vision network for routine vision services can contact Envolve Vision at 1-800-531-2818. Members will receive a 90-day transition of care period if the member is receiving ongoing care and treatment. Call us to get this form. 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. 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. As of April 1, 2021, all WellCare of South Carolina Medicaid members will transfer to Absolute Total Care. However, there will be no members accessing/assigned to the Medicaid portion of the agreement. 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 hearing officer will decide whether our decision was right or wrong. We would like to help your billing department get your EDI (claims and real time) transactions processed as efficiently as possible. A. We will notify you orally and in writing. Example of how to properly split claim that span the cutover date of April 1, 2021: Q. Q. Instructions on how to submit a corrected or voided claim. Farmington, MO 63640-3821. 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. With the completion of this transaction, we have created a premier healthcare enterprise focused on government-sponsored healthcare programs. Earliest From Dates on or after April 1, 2021 should be filed to Absolute Total Care. 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. If you are unable to view PDFs, please download Adobe Reader. 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. 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. 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. Providers interested in joining the Absolute Total Care vision network for routine vision services can contact Envolve Vision at 1-800-531-2818. Members can continue to receive services from their current WellCare provider as long as they remain covered under WellCare. If Statement Range is March 14, 2021 through April 3, 2021, please send to WellCare. For requests involving dates of service on April 1, 2021 and beyond, Absolute Total Care will follow Medicaid contract requirements allowing a 90-day transition of care period. Q. Federal Employee Program (FEP) Federal Employee Program P.O. Explains how to receive, load and send 834 EDI files for member information. The Medicare portion of the agreement will continue to function in its entirety as applicable. Claims will be processed according to timely filing provisions in the providers WellCare Participating Provider Agreement. Wfu neebybfgnh bgWfulnybfgC South Carolina Medicaid Provider Resource Guide Thank you for being a star member of our provider team. We want to ensure that claims are handled as efficiently as possible. As of April 1, 2021, WellCare will no longer be a separate plan option offered by South Carolina Healthy Connections Choices. Box 3050 Providers can help facilitate timely claim payment by having an understanding of our processes and requirements. Box 3050 Claims will be processed according to timely filing provisions in the providers WellCare Participating Provider Agreement. Register now at https://www.payspanhealth.comor contact PaySpan at providersupport@payspanhealth.com, or 877-331-7154. A. Know the facts about Coronavirus (COVID-19) Our call centers, including the nurse advice line, are currently experiencing high volume. South Carolina DEPARTMENT OF HEALTH AND HUMAN SERVICES Post Office Box 8206 Columbia, South Carolina 29202-8206 www.scdhhs.gov November 24, 2009 ALL . People of all ages can be infected. Provider can't require members to appoint them as a condition of getting services. Our fax number is 1-866-201-0657. Additionally, WellCare will have a migration section on their provider webpage publishing FAQs. WellCare of North Carolina partners with providers to develop and deliver high-quality, cost-effective health care solutions. How will credentialing/recredentialing be handled by Absolute Total Care if a provider was recently credentialed/recredentialed by WellCare? WellCare offers participating providers EFT and ERA services at no charge through PaySpan Health. Earliest From Dates prior to 4/1/2021 should be filed to WellCare of South Carolina. Q. Pharmacy services prior to 4/1/2021 must be requested from WellCare South Carolina. A. PROVIDER REMINDER: It is important that providers check eligibility prior to providing services as members can potentially change plans prior to 4/1/2021 if they are in the annual choice period. 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. 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. * Username. Coronavirus Disease 2019 (COVID-19) causes respiratory illness in people and can spread from person to person. A. WellCare credentialing cycles will be shared with Absolute Total Care in order to reduce duplicative credentialing in the future. Select your topic and plan and click "Chat Now!" to chat with a live agent! WellCare and Absolute Total Care Medicare plans will continue to operate under current brands, product names and provider contracts, until further notice. 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 . endstream endobj startxref 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. Please see list of services that will require authorization during this time. Providers can help facilitate timely claim payment by having an understanding of our processes and requirements. WellCare credentialing cycles will be shared with Absolute Total Care in order to reduce duplicative credentialing in the future. The way your providers or others act or treat you. We may apply a 14 day extension to your grievance resolution. Get an annual flu shot today. Register now. 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. That's why we provide tools and resources to help. This manual sets forth the policies and procedures that providers participating in the Wellcare Prime network are required to follow. You may file your second level grievance review within 30 days of receiving your grievance decision letter. 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. A. 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. A grievance is when you tell us about a concern you have with our plan. A. * Password. Members will receive a 90-day transition of care period if the member is receiving ongoing care and treatment. Q: What is Absolute Total Cares Transition/Continuity of Care Policy? Members must have Medicaid to enroll. You can ask for a State Fair Hearing after we make our appeal decision. You or your authorized representative can review the information we used to make our decision. From Date Institutional Statement Dates prior to 4/1/2021 should be filed to WellCare of South Carolina. 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. How do I determine if an institutional inpatient bill type submission overlapping 4/1/2021 should be filed to WellCare or Absolute Total Care? A. Keep yourself informed about Coronavirus (COVID-19.) Guides Filing Claims with WellCare. Earliest From Dates on or after 4/1/2021 should be filed to Absolute Total Care. WellCare and Absolute Total Care Medicare plans will continue to operate under current brands, product names and provider contracts, until further notice. All dates of service prior to April 1, 2021 should be filed to WellCare of South Carolina. You or your authorized representative will tell the hearing officer why you think we made the wrong decision. Contact Absolute Total Care Provider Service at1-866-433-6041if youhave questions. Download the free version of Adobe Reader. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. Providers can help facilitate timely claim payment by having an understanding of our processes and requirements. Will my existing WellCare patients be assigned to my Absolute Total Care Panel? April 1-April 3, 2021, please send to Absolute Total Care. Utilize interactive health and wellness tools to help you manage conditions, improve your health and save money. (This includes your PCP or another provider.) In South Carolina, WellCare and Absolute Total Care are joining to better serve you. You must file your appeal within 60 calendar days from the date on the NABD. Download the free version of Adobe Reader. 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. hb```b``6``e`~ "@1V NB, The timely filing limit is the time duration from service rendered to patients and submitting claims to the insurance companies. 2023 Medicare and PDP Compare Plans and Enroll Now. Awagandakami You now have access to a secure, quick way to electronically settle claims. Q. Always verify timely filing requirements with the third party payor. 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. It will let you know we received your appeal. 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 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. What is the Rx BIN and Group Number for WellCare members transitioning to Absolute Total Care on April 1, 2021? Member Appeals (Medical, Behavioral Health, and Pharmacy): You will need Adobe Reader to open PDFs on this site. Overview & Resources WellCare of North Carolina partners with providers to develop and deliver high-quality, cost-effective health care solutions. Absolute Total Care will continue to offer Marketplace products under the Ambetter brand. It can also be about a provider and/or a service. We will review it and send you a decision letter within 30 calendar days from receiving your appeal. ?-}++lz;.0U(_I]:3O'~3-~%-JM Box 100605 Columbia, SC 29260. Please use WellCare Payor ID 14163. To avoid rejections please split the services into two separate claim submissions. The annual flu vaccine helps prevent the flu.Protect yourself and those around you. Absolute Total Care To write us, send mail to: You can fax it too. Within five business days of getting your grievance, we will mail you a letter. Tampa, FL 33631-3372. We will give you information to help you get the most from your benefits and the services we provide. 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? Division of Appeals and Hearings 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. No, Absolute Total Care will continue to operate under the Absolute Total Care name. In South Carolina, WellCare and Absolute Total Care are joining to better serve you. Q. Our call centers, including the nurse advice line, are currently experiencing high volume. At the hearing, well explain why we made our decision. As of April 1, 2021, all WellCare of South Carolina Medicaid members will transfer to Absolute Total Care. 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. 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. You or your provider must call or fax us to ask for a fast appeal. 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 standard requests, if you call in your appeal, you must follow up with a written, signed one, within thirty calendar days. We have licensed clinicians available to speak with you and to connect you to the support you need to feel better. It is 30 days to 1 year and more and depends on . However, there will be no members accessing/assigned to the Medicaid portion of the agreement. How do I join Absolute Total Cares provider network? 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 Finding a doctor is quick and easy. We will also send you a letter with our decision within 72 hours from receiving your appeal. A. Our toll-free fax number is 1-877-297-3112. Box 8206 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? Q. You can get many of your Coronavirus-related questions answered here. WellCare claims will be processed according to timely filing provisions in the providers WellCare Participating Provider Agreement. pst/!+ Y^Ynwb7tw,eI^ Written notice is not needed if your expedited appeal request is filed verbally. S< Q. Q. Reimbursement Policies Exceptions to the one-year time limit: a) Medicare Cost Sharing Claims . The rules include what we must do when we get a grievance. If an authorization is needed, you can log in to the Secure Provider Portal at absolutetotalcare.com to submit and confirm authorizations. 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. Q. #~0 I 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. Box 31224 We expect this process to be seamless for our valued members, and there will be no break in their coverage. WellCare of North Carolina will begin to release medical payments to providers beginning July 6, 2021. South Carolina Department of Health and Human Services Division of Appeals and Hearings P.O. The Medicare portion of the agreement will continue to function in its entirety as applicable. Addakam ditoy para kenka. Claims for services prior to April 1, 2021 should be filed to WellCare for processing. 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. Q. $8v + Yu @bAD`K@8m.`:DPeV @l To do this: The provider needs to contact Absolute Total Care to arrange continuing care. 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! We will send you another letter with our decision within 90 days or sooner. 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. Examples: If Statement Range is March 14, 2021 through April 3, 2021, please send to WellCare. You can get many of your Coronavirus-related questions answered here. More Information Coronavirus (COVID-19) DOS April 1, 2021 and after: Processed by Absolute Total Care. z4M0(th`1Lf`M18c BIcJ[%4l JU2 _ s 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 must have your written permission before someone can file a grievance for you. Members will need to talk to their provider right away if they want to keep seeing him/her. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. 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. These materials are for informational purposes only. The participating provider agreement with WellCare will remain in-place after April 1, 2021. WellCare of South Carolina will be known as Absolute Total Care as of April 1, 2021. 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. 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. How do I determine if a professional or an outpatient bill type institutional submission should be filed to WellCare or Absolute Total Care? We cannot disenroll you from our plan or treat you differently. Box 31384 If you need claim filing assistance, please contact your provider advocate. 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 . Pregnant members receiving care from an out-of-network Obstetrician can continue to see their current obstetrician until after the baby is born. BlueCross BlueShield of South Carolina Piedmont Service Center P.O. You may do this in writing or in person. Professional and Institutional Fee-For-Service EDI transactions should be submitted to WellCare of South Carolina Medicaid with Payer ID 14163. 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. The provider needs to contact Absolute Total Care to arrange continuing care. Claim Filing Manual - First Choice by Select Health of South Carolina Claims for services on or after April 1, 2021 should be filed to Absolute Total Care for processing. 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. The onlineProvider Manual represents the most up-to-date information on Absolute Total Cares Medicaid Plan, programs, policies, and procedures. We process check runs daily, with the exception of Sundays, National Holidays, and the last day of the month. Instructions on how to submit a corrected or voided claim. 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. 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. However, there will be no members accessing/assigned to the Medicaid portion of the agreement. DOS prior to April 1, 2021: Processed by WellCare. WellCare Medicare Advantage Claims must be filed within 180 calendar days from the date of service. Your second-level review will be performed by person(s) not involved in the first review. For requests involving dates of service on April 1, 2021 and beyond, Absolute Total Care will follow Medicaid contract requirements allowing a 90-day transition of care period. The second level review will follow the same process and procedure outlined for the initial review. %PDF-1.6 % Initial Claims: 120 Days from the Date of Service. Please use the earliest From Date. 941w*)bF iLK\c;nF mhk} Box 31224 Box 6000 Greenville, SC 29606. 1096 0 obj <>stream Explains rules and state, line of business and CMS-specific regulations regarding 837P EDI transactions. P.O. Absolute Total Care will honor all existing WellCare authorization approvals that include dates of service beyond March 31, 2021. Attn: Grievance Department 2) Reconsideration or Claim disputes/Appeals. All billing requirements must be adher ed to by the provider in order to ensure timely processing of claims. You will receive an acknowledgement letter within 5 business days, and we will send you a resolution within 90 calendar days. We are glad you joined our family! 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. Payments mailed to providers are subject to USPS mailing timeframes. Shop or Enroll in a Plan Frequently Asked Questions Find a Doctor Download Digital ID Card Welcome Allwell Members! We will continue covering your medical services during your appeal request and State Fair Hearing if all of the following are meet. You must ask within 30 calendar days of getting our decision. WellCare is the health care plan that puts you in control. Will WellCare continue to offer current products or Medicare only? The materials located on our website are for dates of service prior to April 1, 2021. 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. Here are some guides we created to help you with claims filing. A hearing officer from the State will decide if we made the right decision. 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. Ambetter from Absolute Total Care - South Carolina. WellCare of South Carolina will be known as Absolute Total Care as of April 1, 2021. 1,flQ*!WLOmsmz\D;I5BI,yA#z!vYQi5'fedREF40 b666q1(UtUJJ.i` (T/@E Date of Occurrence/DOSApril 1, 2021 and after: Processed by Absolute Total Care. WellCare has partnered with Change Healthcare as our preferred EDI Clearinghouse. A. 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.
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