We may apply a 14 day extension to your grievance resolution. March 14-March 31, 2021, please send to WellCare. This manual sets forth the policies and procedures that providers participating in the Wellcare Prime network are required to follow. Where should I submit claims for WellCare Medicaid members? It is 30 days to 1 year and more and depends on . We expect this process to be seamless for our valued members and there will be no break in their coverage. An appeal may be filed within 60 calendar days from the date on the Adverse Benefit Determination Notice. We try to make filing claims with us as easy as possible. 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 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 has partnered with Change Healthcare as our preferred EDI Clearinghouse. At the hearing, well explain why we made our decision. 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. The participating provider agreement with WellCare will remain in-place after 4/1/2021. You can ask for a State Fair Hearing after we make our appeal decision. Here are some guides we created to help you with claims filing. Q: What is Absolute Total Cares Transition/Continuity of Care Policy? Please Explore the Site and Get To Know Us. As of April 1, 2021, WellCare will no longer be a separate plan option offered by South Carolina Healthy Connections Choices. 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. L]4(f4/pn~YTZSp-5/O*F)e~p:a6o{x8r 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 WellCare of North Carolina will begin to release medical payments to providers beginning July 6, 2021. 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. How do I determine if a professional or an outpatient bill type institutional submission should be filed to WellCare or Absolute Total Care? Claims will be processed according to timely filing provisions in the providers Absolute Total Care Participating Provider Agreement. You will have a limited time to submit additional information for a fast appeal. 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. Within five business days of getting your grievance, we will mail you a letter. pst/!+ Y^Ynwb7tw,eI^ Claims Department You can make three types of grievances. The materials located on our website are for dates of service prior to April 1, 2021. 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. Earliest From Dates on or after April 1, 2021 should be filed to Absolute Total Care. Section 1: General Information. In South Carolina, WellCare and Absolute Total Care are joining to better serve you. No, Absolute Total Care will continue to operate under the Absolute Total Care name. Wellcare uses cookies. 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. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. It can also be about a provider and/or a service. We understand that maintaining a healthy community starts with providing care to those who need it most. WellCare of South Carolina will be known as Absolute Total Care as of April 1, 2021. z4M0(th`1Lf`M18c BIcJ[%4l JU2 _
s The onlineProvider Manual represents the most up-to-date information on Wellcare Prime by Absolute Total Care (Medicare-Medicaid Plan), programs, policies, and procedures. Effective January 1, 2015 the South Carolina Department of Health and Human Services (SCDHHS) will implement a Claim Reconsideration Policy. Please use WellCare Payor ID 14163. Symptoms are flu-like, including: Fever Coughing 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. 1071 0 obj
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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. Provider can't require members to appoint them as a condition of getting services. In this section, we will explain how you can tell us about these concerns/grievances. 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. Call us to get this form. The participating provider agreement with WellCare will remain in-place after 4/1/2021. 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). Explains rules and state, line of business and CMS-specific regulations regarding 837I EDI transactions. How do I determine if an institutional inpatient bill type submission overlapping 4/1/2021 should be filed to WellCare or Absolute Total Care? Providers are encouraged to sign up to receive EFT payments to avoid any payment delays. 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. WellCare Medicare Advantage Claims must be filed within 180 calendar days from the date of service. Q. 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. With the completion of this transaction, we have created a premier healthcare enterprise focused on government-sponsored healthcare programs. Our call centers, including the nurse advice line, are currently experiencing high volume. For dates of service prior to April 1, 2021: All paper claim submissions can be mailed to: WellCare Health Plans North Carolina PHP Billing Guidance for Local W Code. Explains rules and state, line of business and CMS-specific regulations regarding 837P EDI transactions. If you dont agree with our appeal decision - and you've completed the appeal steps with our health plan - or, if our appeal decision was not made within the required timeframe (30-calendar days for standard appeals or 72 hours for fast appeals), you may request a State Fair Hearing. However, there will be no members accessing/assigned to the Medicaid portion of the agreement. Get an annual flu shot today. 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. 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. The provider needs to contact Absolute Total Care to arrange continuing care. 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. Members must have Medicaid to enroll. Forms. What is the Rx BIN and Group Number for WellCare members transitioning to Absolute Total Care on April 1, 2021? From Date Institutional Statement Dates prior to 4/1/2021 should be filed to WellCare of South Carolina. Want to receive your payments faster to improve cash flow? 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. 837 Institutional Encounter 5010v Guide Incorrect forms will not be considered and may lead to further delays in processing prior authorization requests. the timely filing limits due to the provider being unaware of a beneficiary's coverage. Claim Filing Manual - First Choice by Select Health of South Carolina 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. You must ask within 30 calendar days of getting our decision. Providers can help facilitate timely claim payment by having an understanding of our processes and requirements. 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. To avoid rejections please split the services into two separate claim submissions. Register now at https://www.payspanhealth.com or contact PaySpan at providersupport@payspanhealth.com, or 877-331-7154. 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. From Date Institutional Statement Dates on or after 4/1/2021 should be filed to Absolute Total Care. Members will receive a 90-day transition of care period if the member is receiving ongoing care and treatment. Ambetter Timely Filing Limit of : 1) Initial Claims. To write us, send mail to: You can fax it too. Box 31224 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. We are proud to announce that WellCare is now part of the Centene Family. Download the free version of Adobe Reader. The state has also helped to set the rules for making a grievance. Q. We have licensed clinicians available to speak with you and to connect you to the support you need to feel better. 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. The Medicare portion of the agreement will continue to function in its entirety as applicable. You can file an appeal if you do not agree with our decision. If you dont, we will have to deny your request. 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. People of all ages can be infected. For the death or injury of a member of the South Carolina National Guard, as provided for in Section 42-7-67, the time for filing a claim is two years after the accident or one year after the federal claim is finalized, whichever is later. 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. The Medicare portion of the agreement will continue to function in its entirety as applicable. 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. We are glad you joined our family! 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. 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. Reconsideration or Claim Disputes/Appeals: 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. 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. Need an account? Select Health Claims must be filed within 12 months from the date of service. 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. 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. 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. An authorized representative is someone you select to act on the behalf of a member to assist them through the appeals process. For standard requests, if you call in your appeal, you must follow up with a written, signed one, within thirty calendar days. As of April 1, 2021, WellCare will no longer be a separate plan option offered by South Carolina Healthy Connections Choices. For example, if a payer has a 90-day timely filing requirement, that means you need to submit the claim within 90 days of the date of service. Member Appeals (Medical, Behavioral Health, and Pharmacy): You will need Adobe Reader to open PDFs on this site. As of April 1, 2021 Absolute Total Care, a Centene company, is now the health plan for South Carolina Medicaid members. Contact Wellcare Prime Provider Service at 1-855-735-4398 if you have questions. WellCare understands that having access to the right tools can help you and your staff streamline day-to-day administrative tasks. All dates of service prior to 4/1/2021 should be filed to WellCare of South Carolina. 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. Register now. Q. Q. 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. Please use the Earliest From Date. More Information Need help? WellCare of South Carolinawants to ensure that claims are handled as efficiently as possible. It is called a "Notice of Adverse Benefit Determination" or "NABD." Claims for services on or after April 1, 2021 should be filed to Absolute Total Care for processing. Copyright 2023 Wellcare Health Plans, Inc. Please be sure to use the correct line of business prior authorization form for prior authorization requests. As of April 1, 2021, all WellCare of South Carolina Medicaid members will become Absolute Total Care members. Wellcare wants to ensure that claims are handled as efficiently as possible. Q. Check out the Interoperability Page to learn more. WellCare of South Carolina will be known as Absolute Total Care as of April 1, 2021. Send your written appeal to: We must have your written consent before someone can file an appeal for you. You, your friend, a relative, legal counsel or other spokesperson who has your written consent may ask for a State Fair Hearing. Wellcare uses cookies. With the completion of this transaction, we have created a premier healthcare enterprise focused on government-sponsored healthcare programs. This gives members time to establish with a new provider in the network and ensure that they have continuity of care. You will get a letter from us when any of these actions occur. 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 B^E{h#XYQv;[ny3Hha1yx4v.sBy jWacQzyL.kHhwtQ~35!Rh#)p+sj31LcC)4*Z:IWIG@WTD- )n,! P.O. Providers can help facilitate timely claim payment by having an understanding of our processes and requirements. You can ask in writing for a State Fair Hearing (hearing, for short). 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. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. Absolute Total Care will honor those authorizations. 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. 2) Reconsideration or Claim disputes/Appeals. hbbd``b`$= $ The way your providers or others act or treat you. However, there will be no members accessing/assigned to the Medicaid portion of the agreement. There is a lot of insurance that follows different time frames for claim submission. 941w*)bF
iLK\c;nF mhk} We welcome Brokers who share our commitment to compliance and member satisfaction. Copyright 2023 Wellcare Health Plans, Inc. Clinical Laboratory Improvement Amendments (CLIA). Ancillary Claims Filing Reminders; ClaimsXten TM: Correct Coding Initiative Reference Guide; Inpatient Non-Reimbursable Charges/Unbundling Policy You will receive an acknowledgement letter within 5 business days, and we will send you a resolution within 90 calendar days. Providers interested in joining the Absolute Total Care Provider Network should submit a request to Network Development and Contracting via email at. Our toll-free fax number is 1-877-297-3112. 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 and Absolute Total Care Medicare plans will continue to operate under current brands, product names and provider contracts, until further notice. April 1-April 3, 2021, please send to Absolute Total Care. Providers are encouraged to visit the Provider Resources webpagefor manuals, forms, and resources related to claims submission, eligibility, prior authorization, and more. We will review it and send you a decision letter within 30 calendar days from receiving your appeal. Learn how you can help keep yourself and others healthy. 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. WellCare offers participating providers EFT and ERA services at no charge through PaySpan Health. In South Carolina, WellCare and Absolute Total Care are joining to better serve you. Providers will continue to follow WellCares Medicaid policies and procedures for services provided to WellCare Medicaid members for dates of service prior to April 1, 2021. Example of how to properly split claim that span the cutover date of April 1, 2021: Q. Tampa, FL 33631-3384. 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. DOS April 1, 2021 and after: Processed by Absolute Total Care. This manual sets forth the policies and procedures that providers participating in the Absolute Total Carenetwork are required tofollow. The provider needs to contact Absolute Total Care to arrange continuing care. Q. Addakam ditoy para kenka. Members will need to talk to their provider right away if they want to keep seeing him/her. WellCare offers participating providers EFT and ERA services at no charge through PaySpan Health. Resources We will notify you orally and in writing. 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 Claims for services prior to April 1, 2021 should be filed to WellCare for processing. 2023 Medicare and PDP Compare Plans and Enroll Now. Welcome to Wellcare By Allwell, a Medicare Advantage plan.
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