Contact Absolute Total Care Provider Service at1-866-433-6041if youhave questions. Q. With the completion of this transaction, we have created a premier healthcare enterprise focused on government-sponsored healthcare programs. The state has also helped to set the rules for making a grievance. 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. Providers can help facilitate timely claim payment by having an understanding of our processes and requirements. A provider can act for a member in hearings with the member's written permission in advance. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. Claims Department Want to receive your payments faster to improve cash flow? Timely filing limits vary. We will send you another letter with our decision within 90 days or sooner. Providers can help facilitate timely claim payment by having an understanding of our processes and requirements. %%EOF L]4(f4/pn~YTZSp-5/O*F)e~p:a6o{x8r Providers can help facilitate timely claim payment by having an understanding of our processes and requirements. How do I determine if an institutional inpatient bill type submission overlapping 4/1/2021 should be filed to WellCare or Absolute Total Care? 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. 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. How do I determine if a professional or an outpatient bill type institutional submission should be filed to WellCare or Absolute Total Care? P.O. An authorized representative is someone you select to act on the behalf of a member to assist them through the appeals process. You can ask for a State Fair Hearing after we make our appeal decision. What will happen to my Participating Provider Agreement with WellCare after 4/1/2021? 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. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. We are committed to improving the quality of life of our millions of members, who often include some of our nations most vulnerable populations. We try to make filing claims with us as easy as possible. Q. Search for primary care providers, hospitals, pharmacies, and more! The hearing officer does not decide in your favor. South Carolina | Wellcare SOUTH CAROLINA Healthcare done well. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. Box 100605 Columbia, SC 29260. Always verify timely filing requirements with the third party payor. 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. More Information Coronavirus (COVID-19) If you dont, we will have to deny your request. For example, if any patient gets services on the 1st of any month then there is a time limit to submit his/her claim to the insurance company for reimbursement. You may request a State Fair Hearing at this address: South Carolina Department of Health Additionally, WellCare will have a migration section on their provider webpage publishing FAQs. Obstetrician care provided by an out of network Obstetrician will be covered for pregnant members inclusive of post-partum 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. We welcome Brokers who share our commitment to compliance and member satisfaction. Welcome to Wellcare By Allwell, a Medicare Advantage plan. 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. 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. Keep yourself informed about Coronavirus (COVID-19.) Those who attend the hearing include: You can also request to have your hearing over the phone. Wellcare uses cookies. Pregnant members receiving care from an out of network Obstetrician can continue to see their current Obstetrician until after the baby is born. However, there will be no members accessing/assigned to the Medicaid portion of the agreement. All dates of service on or after 4/1/2021 should be filed to Absolute Total Care. 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. WellCare of North Carolina partners with providers to develop and deliver high-quality, cost-effective health care solutions. Providers interested in joining the Absolute Total Care Provider Network should submit a request to Network Development and Contracting via email at atc_contracting@centene.com. Claims for services prior to April 1, 2021 should be filed to WellCare for processing. Here you will find the tools and resources you need to help manage your submission of claims and receipt of payments. Will WellCare continue to offer current products or Medicare only? Professional and Institutional Encounter EDI transactions should be submitted to WellCare of South Carolina Medicaid with Payer ID 59354. Providers can begin requesting prior authorization for pharmacy services from Absolute Total Care for dates of service on or after April 1, 2021 from Absolute Total Care on April 1, 2021. WellCare has partnered with Change Healthcare as our preferred EDI Clearinghouse. Register now. The provider needs to contact Absolute Total Care to arrange continuing care. 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. Date of Occurrence/DOSprior toApril 1, 2021: Processed by WellCare. How do I join Absolute Total Cares provider network? For general questions about claims submissions, call Provider Claims Services at 1-800-575-0418. 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. 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. 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. You will have a limited time to submit additional information for a fast appeal. Beginning. We expect this process to be seamless for our valued members and there will be no break in their coverage. From Date Institutional Statement Dates prior to April 1, 2021 should be filed to WellCare of South Carolina. Additionally, WellCare will have a migration section on their provider page at publishing FAQs. Tampa, FL 33631-3372. Explains rules and state, line of business and CMS-specific regulations regarding 837I EDI transactions. Wellcare uses cookies. All Paper Claim Submissions can be mailed to: WellCare Health Plans Obstetrician care provided by an out-of-network obstetrician will be covered for pregnant members inclusive of postpartum care. Exceptions to the one-year time limit: a) Medicare Cost Sharing Claims . Awagandakami April 1-April 3, 2021, please send to Absolute Total Care. Providers interested in joining the Absolute Total Care Provider Network should submit a request to Network Development and Contracting via email at. Absolute Total Care will honor those authorizations. Instructions on how to submit a corrected or voided claim. You will need Adobe Reader to open PDFs on this site. Members can continue to receive services from their current WellCare provider as long as they remain covered under WellCare. A. WellCare of South Carolinawants to ensure that claims are handled as efficiently as possible. Incorrect forms will not be considered and may lead to further delays in processing prior authorization requests. Q. * Username. Earliest From Dates on or after April 1, 2021 should be filed to Absolute Total Care. Please contact our Provider Services Call Center at 1-888-898-7969. Division of Appeals and Hearings A. WellCare claims will be processed according to timely filing provisions in the providers WellCare Participating Provider Agreement. 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. How are WellCare Medicaid member authorizations being handled after April 1, 2021? A. 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! A. Date of Occurrence/DOSApril 1, 2021 and after: Processed by Absolute Total Care. 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. Wellcare uses cookies. A. First Choice can accept claim submissions via paper or electronically (EDI). Send your written appeal to: We must have your written consent before someone can file an appeal for you. These materials are for informational purposes only. 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. Q. 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. 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. 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. 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. BlueCross BlueShield of South Carolina Piedmont Service Center P.O. (This includes your PCP or another provider.) It is 30 days to 1 year and more and depends on . Tampa, FL 33631-3384. 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 understand that maintaining a healthy community starts with providing care to those who need it most. This person has all beneficiary rights and responsibilities during the appeal process. WellCare Medicare members are not affected by this change. WellCare of South Carolina will be known as Absolute Total Care as of April 1, 2021. 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. We have licensed clinicians available to speak with you and to connect you to the support you need to feel better. Members can continue to receive services from their current WellCare provider as long as they remain covered under WellCare. If Statement Range is April 2, 2021 through April 10, 2021, please send to Absolute Total Care. 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. 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. 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 The Medicare portion of the agreement will continue to function in its entirety as applicable. Box 3050 How will credentialing/recredentialing be handled by Absolute Total Care if a provider was recently credentialed/recredentialed by WellCare? DOSApril 1, 2021 and after: Processed by Absolute Total Care. 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 Providers can begin requesting prior authorization from Absolute Total Care for dates of service on or after April 1, 2021 from Absolute Total Care on March 15, 2021. P.O. North Carolina PHP Billing Guidance for Local W Code. If you request a hearing, the request must: A State Fair Hearing is a legal proceeding. This gives members time to establish with a new provider in the network and ensure that they have continuity of care. Please use the From Date Institutional Statement Date. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. Addakam ditoy para kenka. You can also have a video visit with a doctor using your phone or computer. Get an annual flu shot today. It can also be about a provider and/or a service. PROVIDERS NOTE:Please send Corrected Claims as normal submissions via electronic or paper. South Carolina DEPARTMENT OF HEALTH AND HUMAN SERVICES Post Office Box 8206 Columbia, South Carolina 29202-8206 www.scdhhs.gov November 24, 2009 ALL . Claims Submission, Correspondence and Contact Resources will stay the same for the Medicare line of business. More Information Need help? 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. 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. As a member you may request a 14 day extension of your grievance, you may do so by calling Member Services at 1-888-588-9842 (TTY 1-877-247-6272) or You may send your request for extension in writing to: WellCare Health Plans 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. Instructions on how to submit a corrected or voided claim. What is the Rx BIN and Group Number for WellCare members transitioning to Absolute Total Care on April 1, 2021? Member Sign-In. 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. Pharmacy services prior to April 1, 2021 must be requested from WellCare of South Carolina. You now have access to a secure, quick way to electronically settle claims. For dates of service prior to April 1, 2021: All paper claim submissions can be mailed to: WellCare Health Plans 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. %PDF-1.6 % 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 This gives members time to establish with a new provider in the network and ensure that they have continuity of care. 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. Copyright 2023 Wellcare Health Plans, Inc. For current information, visit the Absolute Total Care website. Explains rules and state, line of business and CMS-specific regulations regarding 837I EDI transactions. Or it can be made if we take too long to make a care decision. Box 31384 For dates of service on or after April 1, 2021: Absolute Total Care 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. 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. 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 . $8v + Yu @bAD`K@8m.`:DPeV @l 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. endstream endobj 1045 0 obj <>/Metadata 50 0 R/OpenAction 1046 0 R/Outlines 160 0 R/Pages 1042 0 R/StructTreeRoot 166 0 R/Type/Catalog/ViewerPreferences<>>> endobj 1046 0 obj <> endobj 1047 0 obj <>/Font<>/ProcSet[/PDF/Text/ImageC/ImageB/ImageI]/XObject<>>>/Rotate 0/StructParents 0/Tabs/S/TrimBox[0.0 0.0 612.0 792.0]/Type/Page>> endobj 1048 0 obj <>stream The onlineProvider Manual represents the most up-to-date information on Absolute Total Cares Medicaid Plan, programs, policies, and procedures. Reimbursement Policies Payments mailed to providers are subject to USPS mailing timeframes. No, Absolute Total Care will continue to operate under the Absolute Total Care name. 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. Q. 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. P.O. 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. At the hearing, well explain why we made our decision. It will let you know we received your appeal. 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. For additional information, questions or concerns, please contact your local Provider Network Management Representative. 941w*)bF iLK\c;nF mhk} The onlineProvider Manual represents the most up-to-date information on Wellcare Prime by Absolute Total Care (Medicare-Medicaid Plan), programs, policies, and procedures. However, there will be no members accessing/assigned to the Medicaid portion of the agreement. Absolute Total 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. Absolute Total Care will honor all existing WellCare authorization approvals that include dates of service beyond March 31, 2021. Members will need to talk to their provider right away if they want to keep seeing him/her. With the completion of this transaction, we have created a premier healthcare enterprise focused on government-sponsored healthcare programs. Claims submission, correspondence, and contact resources will stay the same for the Medicare line of business. Symptoms are flu-like, including: Fever Coughing Additionally, WellCare will have a migration section on their provider page at publishing FAQs. 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.