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. 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. You will get a letter from us when any of these actions occur. Claims will be processed according to timely filing provisions in the providers WellCare Participating Provider Agreement. We are glad you joined our family! Attn: Grievance Department Providers are encouraged to visit the Provider Resources webpagefor manuals, forms, and resources related to claims submission, eligibility, prior authorization, and more. BlueCross BlueShield of South Carolina Piedmont Service Center P.O. Exceptions to the one-year time limit: a) Medicare Cost Sharing Claims . A. Contact Us Y0020_WCM_100876E Last Updated On: 10/1/2022 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. What will happen to my Participating Provider Agreement with WellCare after 4/1/2021? You must ask within 30 calendar days of getting our decision. Copyright 2023 Wellcare Health Plans, Inc. Clinical Laboratory Improvement Amendments (CLIA). Timely filing limits vary. 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! 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. A. Providers can help facilitate timely claim payment by having an understanding of our processes and requirements. 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. From Date Institutional Statement Dates on or after 4/1/2021 should be filed to Absolute Total Care. Claims submission, correspondence, and contact resources will stay the same for the Medicare line of business. * Password. Reconsideration or Claim Disputes/Appeals: Date of Occurrence/DOSprior toApril 1, 2021: Processed by WellCare. If Statement Range is April 2, 2021 through April 10, 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 atc_contracting@centene.com. Reimbursement Policies 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. 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. How do I bill a professional submission with services spanning before and after 04/01/2021? Q. You can file your appeal by calling or writing to us. 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. Please use the From Date Institutional Statement Date. We encourage you to check the Medicaid Pre-Auth Check Toolto ensure that you are accessing the most current Absolute Total Care authorization requirements for dates of service on or after April 1, 2021. More Information Coronavirus (COVID-19) By continuing to use our site, you agree to our Privacy Policy and Terms of Use. DOS prior toApril 1, 2021: Processed by WellCare. Professional and Institutional Encounter EDI transactions should be submitted to WellCare of South Carolina Medicaid with Payer ID 59354. All dates of service on or after 4/1/2021 should be filed to Absolute Total Care. Incorrect forms will not be considered and may lead to further delays in processing prior authorization requests. The hearing officer does not decide in your favor. The materials located on our website are for dates of service prior to April 1, 2021. 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 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. 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. You can ask for a State Fair Hearing after we make our appeal decision. As of April 1, 2021 Absolute Total Care, a Centene company, is now the health plan for South Carolina Medicaid members. Claims Submission, Correspondence and Contact Resources will stay the same for the Medicare line of business. For general questions about claims submissions, call Provider Claims Services at 1-800-575-0418. A. Member Appeals (Medical, Behavioral Health, and Pharmacy): You will need Adobe Reader to open PDFs on this site. Will Absolute Total Care continue to offer Medicare and Marketplace products? You and the person you choose to represent you must sign the AOR form. WellCare of South Carolina will be known as Absolute Total Care as of April 1, 2021. Q. Our fax number is 1-866-201-0657. 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. For current information, visit the Absolute Total Care website. Claims will be processed according to timely filing provisions in the providers WellCare Participating Provider Agreement. As of April 1, 2021, all WellCare of South Carolina Medicaid members will transfer to Absolute Total Care. 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. We expect this process to be seamless for our valued members and there will be no break in their coverage. 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. Explains rules and state, line of business and CMS-specific regulations regarding 837I EDI transactions. 941w*)bF iLK\c;nF mhk} This gives members time to establish with a new provider in the network and ensure that they have continuity of 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. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. An appeal may be filed within 60 calendar days from the date on the Adverse Benefit Determination Notice. Wellcare uses cookies. 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. Pharmacy services prior to 4/1/2021 must be requested from WellCare South Carolina. Contact Absolute Total Care Provider Service at1-866-433-6041if youhave questions. Absolute Total Care will honor those authorizations. 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. As of April 1, 2021, all WellCare of South Carolina Medicaid members will become Absolute Total Care members. 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. To do this: Be sure to ask us to continue your benefits within the 10 calendar day time frame. Professional and Institutional Fee-For-Service EDI transactions should be submitted to WellCare of South Carolina Medicaid with Payer ID 14163. Absolute Total Care will honor those authorizations. N .7$* P!70 *I;Rox3 ] LS~. Addakam ditoy para kenka. Claims will be processed according to timely filing provisions in the providers Absolute Total Care Participating Provider Agreement. 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 members are not affected by this change. You can get many of your Coronavirus-related questions answered here. 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. Claims for services on or after April 1, 2021 should be filed to Absolute Total Care for processing. For dates of service on or after April 1, 2021: Absolute Total Care To avoid rejections please split the services into two separate claim submissions. Claim Filing Manual - First Choice by Select Health of South Carolina You do not appeal within 10 calendar days from when the Plan mails an adverse Notice of Action, or you do not request a hearing within 10 calendar days from when the Plan mails an adverse Notice of Appeals Resolution whichever is later. 8h} \x p`03 1z`@+`~70 G ~Ws5Puick79,4 ,O5@?O-Gr'|5Oj:v6/` Members will need to talk to their provider right away if they want to keep seeing him/her. There is a lot of insurance that follows different time frames for claim submission. (This includes your PCP or another provider.) You or your provider must call or fax us to ask for a fast appeal. Electronic and Paper Claims Submissions; Institutional Claims/Encounter Guides. Timely filing is when you file a claim within a payer-determined time limit. Farmington, MO 63640-3821. We will notify you orally and in writing. Hearings are used when you were denied a service or only part of the service was approved. 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. 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. Professional and Institutional Fee-For-Service EDI transactions should be submitted to WellCare of South Carolina Medicaid with Payer ID 14163. Box 31224 P.O. Within five business days of getting your grievance, we will mail you a letter. Please make sure you ask your members for a copy of their Absolute Total Care and Healthy Connections Choices Medicaid ID cards before each visit. WellCare 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. 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. Q: What is Absolute Total Cares Transition/Continuity of Care Policy? Box 8206 Columbia, SC 29202-8206 Or call 1-800-763-9087. Q. It is called a "Notice of Adverse Benefit Determination" or "NABD." %%EOF For additional information, questions or concerns, please contact your local Provider Network Management Representative. From Date Institutional Statement Dates prior to April 1, 2021 should be filed to WellCare of South Carolina. 837 Institutional Encounter 5010v Guide Please see list of services that will require authorization during this time. Forms. People of all ages can be infected. Wellcare wants to ensure that claims are handled as efficiently as possible. Will WellCare continue to offer current products or Medicare only? 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. This must be done within 120 days from the date of Notice of Appeal Resolution you received from us. Kasapulam ti tulong? You now have access to a secure, quick way to electronically settle claims. As of April 1, 2021, WellCare will no longer be a separate plan option offered by South Carolina Healthy Connections Choices. Farmington, MO 63640-3821. WellCare Medicare members are not affected by this change. Or it can be made if we take too long to make a care decision. Explains how to receive, load and send 834 EDI files for member information. 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 . Absolute Total Care will honor all existing WellCare authorization approvals that include dates of service beyond March 31, 2021. The provider needs to contact Absolute Total Care to arrange continuing care. Absolute Total Care will continue to offer Marketplace products under the Ambetter brand. However, there will be no members accessing/assigned to the Medicaid portion of the agreement. At the hearing, well explain why we made our decision. 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 South Carolina Department of Health and Human Services Division of Appeals and Hearings P.O. 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. Welcome to Wellcare By Allwell, a Medicare Advantage plan. 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. A. Members will receive a 90-day transition of care period if the member is receiving ongoing care and treatment. Please use WellCare Payor ID 14163. We will give you information to help you get the most from your benefits and the services we provide. Learn how you can help keep yourself and others healthy. Send your written appeal to: We must have your written consent before someone can file an appeal for you. Outpatient Prior Authorization Form (PDF) Inpatient Prior Authorization Form (PDF) Contact Wellcare Prime Provider Service at1-855-735-4398if youhave questions. Absolute Total Care will honor those authorizations. To do so by phone, call Member Services at 1-888-588-9842 (TTY1-877-247-6272). 2) Reconsideration or Claim disputes/Appeals. It is 30 days to 1 year and more and depends on . 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. 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. A. You will receive an acknowledgement letter within 5 business days, and we will send you a resolution within 90 calendar days. WellCare of North Carolina partners with providers to develop and deliver high-quality, cost-effective health care solutions. \{-w{,xI202100$0*bZf ,X AayhP3pYla" e 3G& `eoT#@ *;d Where should I submit claims for WellCare Medicaid members that transition to Absolute Total Care? In South Carolina, WellCare and Absolute Total Care are joining to better serve you. Will Absolute Total Care change its name to WellCare? Box 6000 Greenville, SC 29606. Examples: If Statement Range is March 14, 2021 through April 3, 2021, please send to WellCare. For dates of service prior to April 1, 2021: All paper claim submissions can be mailed to: WellCare Health Plans Forgot Your Password? This manual sets forth the policies and procedures that providers participating in the Absolute Total Carenetwork are required tofollow. With the completion of this transaction, we have created a premier healthcare enterprise focused on government-sponsored healthcare programs. 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. WellCare of North Carolina will begin to release medical payments to providers beginning July 6, 2021. The provider needs to contact Absolute Total Care to arrange continuing care. 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. Ambetter Timely Filing Limit of : 1) Initial Claims. We are proud to announce that WellCare is now part of the Centene Family. 1,flQ*!WLOmsmz\D;I5BI,yA#z!vYQi5'fedREF40 b666q1(UtUJJ.i` (T/@E hb```b``6``e`~ "@1V NB, Box 8206 You will have a limited time to submit additional information for a fast appeal. 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. 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. You may request a State Fair Hearing at this address: South Carolina Department of Health 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 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. 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. Explains how to receive, load and send 834 EDI files for member information. Claims for services prior to April 1, 2021 should be filed to WellCare for processing. 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. Claims for services prior to April 1, 2021 should be filed to WellCare for processing. 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. 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. We are proud to announce that WellCare is now part of the Centene Family. Wellcare uses cookies. A provider can act for a member in hearings with the member's written permission in advance. 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. 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. Providers are encouraged to sign up to receive EFT payments to avoid any payment delays. This person has all beneficiary rights and responsibilities during the appeal process. You will need Adobe Reader to open PDFs on this site. WellCare of South Carolina will be known as Absolute Total Care as of April 1, 2021. Box 31224 Refer to your particular provider type program chapter for clarification. Awagandakami The state has also helped to set the rules for making a grievance. * Username. Payments mailed to providers are subject to USPS mailing timeframes. In South Carolina, WellCare and Absolute Total Care are joining to better serve you. We cannot disenroll you from our plan or treat you differently. 2023 Medicare and PDP Compare Plans and Enroll Now. 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. To write us, send mail to: You can fax it too. Tampa, FL 33631-3372. We expect this process to be seamless for our valued members, and there will be no break in their coverage. Obstetrician care provided by an out-of-network obstetrician will be covered for pregnant members inclusive of postpartum care. Please be sure to use the correct line of business prior authorization form for prior authorization requests. Molina Healthcare of Michigan, 100 W. Big Beaver Road, Suite 600 Attn: Claims, Troy, MI 48084-5209 Or Fax to: (248) 925-1768. 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. Claims Department Please Explore the Site and Get To Know Us. Utilize interactive health and wellness tools to help you manage conditions, improve your health and save money. If an authorization is needed, you can log in to the Secure Provider Portal at absolutetotalcare.com to submit and confirm authorizations. Explains rules and state, line of business and CMS-specific regulations regarding 837I EDI transactions. Q. As of April 1, 2021, all WellCare of South Carolina Medicaid members will transfer to Absolute Total Care. Providers can help facilitate timely claim payment by having an understanding of our processes and requirements. Register now. They must inform their vendor of AmeriHealth Caritas . A.