Professional and Institutional Fee-For-Service EDI transactions should be submitted to WellCare of South Carolina Medicaid with Payer ID 14163. How do I bill a professional submission with services spanning before and after 04/01/2021? An authorized representative is someone you select to act on the behalf of a member to assist them through the appeals process. The hearing officer does not decide in your favor. You or your authorized representative will tell the hearing officer why you think we made the wrong decision. We are glad you joined our family! More Information Coronavirus (COVID-19) #~0 I At the hearing, well explain why we made our decision. Date of Occurrence/DOSprior toApril 1, 2021: Processed by WellCare. 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. This manual sets forth the policies and procedures that providers participating in the Wellcare Prime network are required tofollow. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. 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. No, Absolute Total Care will continue to operate under the Absolute Total Care name. This manual sets forth the policies and procedures that providers participating in the Absolute Total Carenetwork are required tofollow. Box 8206 Tampa, FL 33631-3372. We will review it and send you a decision letter within 30 calendar days from receiving your appeal. 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. 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. You will receive an acknowledgement letter within 5 business days, and we will send you a resolution within 90 calendar days. We will do this as quickly as possible as but no longer than 72-hours from the decision. Copyright 2023 Wellcare Health Plans, Inc. WellCare of South Carolinawants to ensure that claims are handled as efficiently as possible. S< A. 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. 941w*)bF iLK\c;nF mhk} Wellcare uses cookies. Shop or Enroll in a Plan Frequently Asked Questions Find a Doctor Download Digital ID Card Welcome Allwell Members! The rules include what we must do when we get a grievance. The participating provider agreement with WellCare will remain in-place after 4/1/2021. WellCare credentialing cycles will be shared with Absolute Total Care in order to reduce duplicative credentialing in the future. For standard requests, if you call in your appeal, you must follow up with a written, signed one, within thirty calendar days. Earliest From Dates prior to 4/1/2021 should be filed to WellCare of South Carolina. you have another option. pst/!+ Y^Ynwb7tw,eI^ To avoid rejections please split the services into two separate claim submissions. 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. 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. 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. 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. We welcome Brokers who share our commitment to compliance and member satisfaction. Exceptions to the one-year time limit: a) Medicare Cost Sharing Claims . A. You can ask in writing for a State Fair Hearing (hearing, for short). Section 1: General Information. 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. That's why we provide tools and resources to help. Select your topic and plan and click "Chat Now!" to chat with a live agent! We expect this process to be seamless for our valued members and there will be no break in their coverage. Contact Wellcare Prime Provider Service at1-855-735-4398if youhave questions. 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. Yes, Absolute Total Care and WellCare will continue to offer Medicare products under their current brands and product names, until further notice. Pharmacy services prior to April 1, 2021 must be requested from WellCare of South Carolina. Absolute Total Care will honor those authorizations. Instructions on how to submit a corrected or voided claim. Instructions on how to submit a corrected or voided claim. Register now at https://www.payspanhealth.comor contact PaySpan at providersupport@payspanhealth.com, or 877-331-7154. April 1-April 3, 2021, please send to Absolute Total Care. 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. You may request a State Fair Hearing at this address: South Carolina Department of Health Box 6000 Greenville, SC 29606. We understand that maintaining a healthy community starts with providing care to those who need it most. It is called a "Notice of Adverse Benefit Determination" or "NABD." Forms. Claims will be processed according to timely filing provisions in the providers Absolute Total Care Participating Provider Agreement. 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. WellCare Medicare Advantage Claims must be filed within 180 calendar days from the date of service. What will happen to unresolved claims prior to the membership transfer? Will my existing WellCare patients be assigned to my Absolute Total Care Panel? B^E{h#XYQv;[ny3Hha1yx4v.sBy jWacQzyL.kHhwtQ~35!Rh#)p+sj31LcC)4*Z:IWIG@WTD- )n,! Q. Explains rules and state, line of business and CMS-specific regulations regarding 837I EDI transactions. Prior authorizations issued by WellCare for dates of service on or after April 1, 2021 will transfer with the members eligibility to Absolute Total Care. 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. If you think you might have been exposed, contact a doctor immediately. We expect this process to be seamless for our valued members, and there will be no break in their coverage. 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. You and the person you choose to represent you must sign the AOR statement. Date of Occurrence/DOSApril 1, 2021 and after: Processed by Absolute Total Care. If you dont, we will have to deny your request. Providers are encouraged to sign up to receive EFT payments to avoid any payment delays. Attn: Grievance Department BlueCross BlueShield of South Carolina Piedmont Service Center P.O. Q: What is Absolute Total Cares Transition/Continuity of Care Policy? Incorrect forms will not be considered and may lead to further delays in processing prior authorization requests. WellCare has partnered with Change Healthcare as our preferred EDI Clearinghouse. Know the facts about Coronavirus (COVID-19) Our call centers, including the nurse advice line, are currently experiencing high volume. Addakam ditoy para kenka. 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. P.O. Members can continue to receive services from their current WellCare provider as long as they remain covered under WellCare. 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. Providers can help facilitate timely claim payment by having an understanding of our processes and requirements. Claims for services prior to April 1, 2021 should be filed to WellCare for processing. This must be done within 120 days from the date of Notice of Appeal Resolution you received from us. Q. Copyright 2023 WellCare Health Plans, Inc. WellCare Non-Emergency Medical Transportation (NEMT) Update, Provider Self-Service Quick Reference Guide (PDF), Provider Masters Level Proposed Rates (PDF), Member Advisory Committee (MAC) Member Flyer (PDF), Member Advisory Committee (MAC) - LTSS Member Flyer (PDF), Managed Care PHP Member PCP Change Request Form (PDF), Provider Referral Form: LTSS Request for PCS Assessment (PDF). 1071 0 obj <>/Filter/FlateDecode/ID[<87133B316ADA4BDD8B85BA48A489D34F>]/Index[1044 53]/Info 1043 0 R/Length 117/Prev 692690/Root 1045 0 R/Size 1097/Type/XRef/W[1 2 1]>>stream With the completion of this transaction, we have created a premier healthcare enterprise focused on government-sponsored healthcare programs. Stay informed - activate your online account Behavioral Health Crisis Line 844-594-5076 (TTY 711) 24 hours a day, seven days a week Call us if you are experiencing emotional or mental pain or distress. Earliest From Dates on or after April 1, 2021 should be filed to Absolute Total Care. DOS prior toApril 1, 2021: Processed by WellCare. A. Please contact our Provider Services Call Center at 1-888-898-7969. Forgot Your Password? To have someone represent you, you must complete an Appointment of Representative (AOR) form. Please be sure to use the correct line of business prior authorization form for prior authorization requests. 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. There is a lot of insurance that follows different time frames for claim submission. Explains rules and state, line of business and CMS-specific regulations regarding 837I EDI transactions. South Carolina DEPARTMENT OF HEALTH AND HUMAN SERVICES Post Office Box 8206 Columbia, South Carolina 29202-8206 www.scdhhs.gov November 24, 2009 ALL . More Information Need help? Electronic and Paper Claims Submissions; Institutional Claims/Encounter Guides. How do I determine if an institutional inpatient bill type submission overlapping 4/1/2021 should be filed to WellCare or Absolute Total Care? To do so by phone, call Member Services at 1-888-588-9842 (TTY1-877-247-6272). PROVIDERS NOTE:Please send Corrected Claims as normal submissions via electronic or paper. Claims for services on or after April 1, 2021 should be filed to Absolute Total Care for processing. 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. 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. The timely filing limit is the time duration from service rendered to patients and submitting claims to the insurance companies. DOS April 1, 2021 and after: Processed by Absolute Total Care. Tampa, FL 33631-3372. Explains rules and state, line of business and CMS-specific regulations regarding 837P EDI transactions. Explains rules and state, line of business and CMS-specific regulations regarding 837P EDI transactions. Download the free version of Adobe Reader. Claims for services prior to April 1, 2021 should be filed to WellCare for processing. We will send you another letter with our decision within 90 days or sooner. You may file your second level grievance review within 30 days of receiving your grievance decision letter. P.O. 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. The Medicare portion of the agreement will continue to function in its entirety as applicable. 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. 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. Box 31384 As of April 1, 2021, all WellCare of South Carolina Medicaid members will transfer to Absolute Total Care. Absolute Total Care Learn how you can help keep yourself and others healthy. Hearings are used when you were denied a service or only part of the service was approved. All dates of service prior to 4/1/2021 should be filed to WellCare of South Carolina. In South Carolina, WellCare and Absolute Total Care are joining to better serve you. These SNP plans provide benefits beyond Original Medicare, and may include transportation to medical appointments and vision exams. You, your friend, a relative, legal counsel or other spokesperson who has your written consent may ask for a State Fair Hearing. We have licensed clinicians available to speak with you and to connect you to the support you need to feel better. An appeal is a request you can make when you do not agree with a decision we made about your care. Earliest From Dates on or after 4/1/2021 should be filed to Absolute Total Care. Providers interested in joining the Absolute Total Care vision network for routine vision services can contact Envolve Vision at 1-800-531-2818. Reconsideration or Claim Disputes/Appeals: The way your providers or others act or treat you. Q. Absolute Total Care will honor all existing WellCare authorization approvals that include dates of service beyond March 31, 2021. They are called: State law allows you to make a grievance if you have any problems with us. Payments mailed to providers are subject to USPS mailing timeframes. For general questions about claims submissions, call Provider Claims Services at 1-800-575-0418. A. 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. 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 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. How are WellCare Medicaid member authorizations being handled after April 1, 2021? Providers can help facilitate timely claim payment by having an understanding of our processes and requirements. Check out the Interoperability Page to learn more. This gives members time to establish with a new provider in the network and ensure that they have continuity of 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. Welcome to WellCare of South Carolina! The hearing officer will decide whether our decision was right or wrong. You must ask within 30 calendar days of getting our decision. For dates of service on or after 4/1/2021: 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. The participating provider agreement with WellCare will remain in-place after 4/1/2021. Wellcare uses cookies. L]4(f4/pn~YTZSp-5/O*F)e~p:a6o{x8r We will give you information to help you get the most from your benefits and the services we provide. 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. Providers are encouraged to visit the Provider Resources webpagefor manuals, forms, and resources related to claims submission, eligibility, prior authorization, and more. However, there will be no members accessing/assigned to the Medicaid portion of the agreement. A. Copyright 2023 Wellcare Health Plans, Inc. Outpatient Prior Authorization Form (PDF) Inpatient Prior Authorization Form (PDF) Payments mailed to providers are subject to USPS mailing timeframes. Box 8206 Columbia, SC 29202-8206 Or call 1-800-763-9087. You may do this in writing or in person. Farmington, MO 63640-3821. Example of how to properly split claim that span the cutover date of April 1, 2021: Q. Want to receive your payments faster to improve cash flow? 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. 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. WellCare of North Carolina will begin to release medical payments to providers beginning July 6, 2021. If you are unable to view PDFs, please download Adobe Reader. We process check runs daily, with the exception of Sundays, National Holidays, and the last day of the month. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. However, there will be no members accessing/assigned to the Medicaid portion of the agreement. 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. Contact Us Y0020_WCM_100876E Last Updated On: 10/1/2022 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. As of April 1, 2021, all WellCare of South Carolina Medicaid members will become Absolute Total Care members. It will let you know we received your appeal. Q. We will call you with our decision if we decide you need a fast appeal. Providers do not need to do anything additional to provide services on or after April 1, 2021 if the provider is in network with both WellCare and Absolute Total Care. As of April 1, 2021, all WellCare of South Carolina Medicaid members will become Absolute Total Care members. 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 To do this: As of April 1, 2021 Absolute Total Care, a Centene company, is now the health plan for South Carolina Medicaid members. 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. Pregnant members receiving care from an out-of-network Obstetrician can continue to see their current obstetrician until after the baby is born. It can also be about a provider and/or a service. 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. 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. For dates of service on or after April 1, 2021: Absolute Total Care P.O. From Date Institutional Statement Dates prior to 4/1/2021 should be filed to WellCare of South Carolina. 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. A. WellCare credentialing cycles will be shared with Absolute Total Care in order to reduce duplicative credentialing in the future. Absolute Total Care will honor those authorizations. Farmington, MO 63640-3821. Claims Department All dates of service on or after April 1, 2021 should be filed to Absolute Total Care. WellCare claims will be processed according to timely filing provisions in the providers WellCare Participating Provider Agreement. WellCare claims will be processed according to timely filing provisions in the providers WellCare Participating Provider Agreement. We want to ensure that claims are handled as efficiently as possible. Absolute Total Care will honor all existing WellCare authorization approvals that include dates of service beyond March 31, 2021. Pregnant members receiving care from an out of network Obstetrician can continue to see their current Obstetrician until after the baby is born. 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. We would like to help your billing department get your EDI (claims and real time) transactions processed as efficiently as possible. Q. 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 provider needs to contact Absolute Total Care to arrange continuing care. What will happen to my Participating Provider Agreement with WellCare after 4/1/2021? Where should I submit claims for WellCare Medicaid members? Overview & Resources WellCare of North Carolina partners with providers to develop and deliver high-quality, cost-effective health care solutions. 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. If an authorization is needed, you can log in to the Secure Provider Portalto submit and confirm authorizations. APPEALS, GRIEVANCES AND PROVIDER DISPUTES. Members will receive a 90-day transition of care period if the member is receiving ongoing care and treatment. 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. March 14-March 31, 2021, please send to WellCare. Written notice is not needed if your expedited appeal request is filed verbally. Please use the Earliest From Date. P.O. If you request a hearing, the request must: A State Fair Hearing is a legal proceeding. We will notify you orally and in writing. 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. P.O. 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. Claims for services on or after April 1, 2021 should be filed to Absolute Total Care for processing. Explains rules and state, line of business and CMS-specific regulations regarding 837P EDI transactions. You will need Adobe Reader to open PDFs on this site. Thanka kaa yoa Tufrbeau ingsnh ngetfu South Caralaita nouMa mpvd. 0 837 Institutional Encounter 5010v Guide Welcome to Wellcare By Allwell, a Medicare Advantage plan. 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 People of all ages can be infected. A. 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. Keep yourself informed about Coronavirus (COVID-19.) WellCare and Absolute Total Care Medicare plans will continue to operate under current brands, product names and provider contracts, until further notice. Guides Filing Claims with WellCare. These materials are for informational purposes only. You will need Adobe Reader to open PDFs on this site. Send your written appeal to: We must have your written consent before someone can file an appeal for you. All dates of service prior to April 1, 2021 should be filed to WellCare of South Carolina. Wellcare wants to ensure that claims are handled as efficiently as possible. A grievance is when you tell us about a concern you have with our plan. All Paper Claim Submissions can be mailed to: WellCare Health Plans 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. We are proud to announce that WellCare is now part of the Centene Family. Members can continue to receive services from their current WellCare provider as long as they remain covered under WellCare. Will WellCare continue to offer current products or Medicare only?