We will continue covering your medical services during your appeal request and State Fair Hearing if all of the following are meet. 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. UnitedHealthcare Dual Complete Special Needs Plan UnitedHealthcare Dual Complete Special Needs Plans (SNP) offer benefits for people with both Medicare and Medicaid. 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. Claims will be processed according to timely filing provisions in the providers Absolute Total Care Participating Provider Agreement. They must inform their vendor of AmeriHealth Caritas . Know the facts about Coronavirus (COVID-19) Our call centers, including the nurse advice line, are currently experiencing high volume. 1096 0 obj
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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. No, Absolute Total Care will continue to operate under the Absolute Total Care name. 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. If you are unable to view PDFs, please download Adobe Reader. P.O. Attn: Grievance Department Please use the From Date Institutional Statement Date. As of April 1, 2021, all WellCare of South Carolina Medicaid members will become Absolute Total Care members. Or you can have someone file it for you. Division of Appeals and Hearings DOSApril 1, 2021 and after: Processed by Absolute Total Care. Symptoms are flu-like, including: Fever Coughing Wellcare uses cookies. 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. For the latest COVID-19 news, visit the CDC. However, as of April 1, 2021, all WellCare of South Carolina Medicaid members will become Absolute Total Care members. To do so by phone, call Member Services at 1-888-588-9842 (TTY1-877-247-6272). 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. It is 30 days to 1 year and more and depends on . Our fax number is 1-866-201-0657. 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. Our call centers, including the nurse advice line, are currently experiencing high volume. Register now at https://www.payspanhealth.com or contact PaySpan at providersupport@payspanhealth.com, or 877-331-7154. Explains rules and state, line of business and CMS-specific regulations regarding 837I EDI transactions. 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. %PDF-1.6
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P.O. Forms. WellCare Medicare members are not affected by this change. We are proud to announce that WellCare is now part of the Centene Family. WellCare Medicare members are not affected by this change. Q. Member Sign-In. When you receive your notification of WellCares grievance resolution, and you are dissatisfied with the resolution regarding adverse decisions that affect your ability to receive benefits, access to care, access to services or payment for care of services, you may request a second level review with WellCare. WellCare Health Plans, Inc. (NYSE: WCG) is now offering a $120 credit per family, per year towards over-the-counter (OTC) items as part of its Medicaid program benefits in South Carolina. To ask for hearing, call 1-800-763-9087 or write to: You also can make a request online using SCDHHS form at https://msp.scdhhs.gov/appeals/site-page/file-appeal. Wellcare uses cookies. Register now at https://www.payspanhealth.comor contact PaySpan at providersupport@payspanhealth.com, or 877-331-7154. More Information Need help? Want to receive your payments faster to improve cash flow? From time to time, WellCare Health Plans reviews its reimbursement policies to maintain close alignment with industry standards and coding updates released by health care industry sources like the Centers for Medicare and Medicaid Services (CMS), and nationally recognized health and medical societies. If Statement Range is April 2, 2021 through April 10, 2021, please send to Absolute Total Care. Please Explore the Site and Get To Know Us. Overview & Resources WellCare of North Carolina partners with providers to develop and deliver high-quality, cost-effective health care solutions. A grievance is when you tell us about a concern you have with our plan. Providers will continue to work directly with WellCare to address any claims for dates of service prior to the membership transfer of April 1, 2021. Claim Filing AmeriHealth Caritas North Carolina, hereafter referred to as the Plan (where appropriate), is required by the North Carolina and federal regulations to capture specific data regarding services rendered to its members. Box 3050 hYnH~}9'I`@>cLq,&DYH"W~&eJx'"luWU]JDBFRJ!*SN(s'6# ^*dg4$SB7K4z:r6')baka+Raf4J=)l,
_/jaSpao69&&_Ln=?/{:,'z .1J0|~jv4[eUN{:-gl! K'&hng?y},&X/|OzcJ@0PhDiO})9RA9tG%=|rBhHBz7 For standard requests, if you call in your appeal, you must follow up with a written, signed one, within thirty calendar days. What will happen to my Participating Provider Agreement with WellCare after 4/1/2021? You can do this at any time during your appeal. WellCare is the health care plan that puts you in control. WellCare Medicare Advantage Claims must be filed within 180 calendar days from the date of service. Explains rules and state, line of business and CMS-specific regulations regarding 837P EDI transactions. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. ?-}++lz;.0U(_I]:3O'~3-~%-JM An authorized representative is someone you select to act on the behalf of a member to assist them through the appeals process. 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. How will credentialing/recredentialing be handled by Absolute Total Care if a provider was recently credentialed/recredentialed by WellCare? As of April 1, 2021, all WellCare of South Carolina Medicaid members will transfer to Absolute Total Care. WellCare claims will be processed according to timely filing provisions in the providers WellCare Participating Provider Agreement. 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. Welcome to WellCare of South Carolina! When can providers begin requesting prior authorization from Absolute Total Care for WellCare Medicaid members for dates of service on or after April 1, 2021? If you request a hearing, the request must: A State Fair Hearing is a legal proceeding. Here are some guides we created to help you with claims filing. A. From time to time, WellCare Health Plans reviews its reimbursement policies to maintain close alignment with industry standards and coding updates released by health care industry sources like the Centers for Medicare and Medicaid Services (CMS), and nationally recognized health and medical societies. For additional information, questions or concerns, please contact your local Provider Network Management Representative. Learn how you can help keep yourself and others healthy. 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. If Statement Range is April 2, 2021 through April 10, 2021, please send to Absolute Total Care. Q. You or your authorized representative can review the information we used to make our decision. You can file your appeal by calling or writing to us. 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. A. 1044 0 obj
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Tampa, FL 33631-3372. and Human Services Welcome to Wellcare By Allwell, a Medicare Advantage plan. The provider needs to contact Absolute Total Care to arrange continuing care. Claims will be processed according to timely filing provisions in the providers Absolute Total Care Participating Provider Agreement. If you think you might have been exposed, contact a doctor immediately. 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. We may apply a 14 day extension to your grievance resolution. Q. Claim Filing Manual - First Choice by Select Health of South Carolina A. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. 2) Reconsideration or Claim disputes/Appeals. Explains rules and state, line of business and CMS-specific regulations regarding 837I EDI transactions. Claims for services on or after April 1, 2021 should be filed to Absolute Total Care for processing. We have licensed clinicians available to speak with you and to connect you to the support you need to feel better. The onlineProvider Manual represents the most up-to-date information on Absolute Total Cares Medicaid Plan, programs, policies, and procedures. Providers can help facilitate timely claim payment by having an understanding of our processes and requirements. Absolute Total Care will honor those authorizations. Your second-level review will be performed by person(s) not involved in the first review. Providers interested in joining the Absolute Total Care vision network for routine vision services can contact Envolve Vision at 1-800-531-2818. Date of Occurrence/DOSApril 1, 2021 and after: Processed by Absolute Total Care. Timely Filing Limits for all Insurances updated (2023) - Bcbsproviderphonenumber Timely Filing Limits for all Insurances updated (2023) One of the common and popular denials is passed the timely filing limit. 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. Q. Additionally, WellCare will have a migration section on their provider page at publishing FAQs. 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. 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. R 1/70.3/Determining End Date of Timely Filing Period -- Receipt Date R 1/70.4/Determination of Untimely Filing and Resulting Actions R 1/70.5/Application to Special Claim Types R 1/70.6/Filing Claim Where General Time Limit Has Expired R 1/70.7/Exceptions Allowing Extension of Time Limit R 1/70.7.1/Administrative Error 2023 Medicare and PDP Compare Plans and Enroll Now Notice of Non-Discrimination We comply with applicable Federal civil rights laws and do not discriminate on the basis of race, color, national origin, age, sex, or disability. Will my existing WellCare patients be assigned to my Absolute Total Care Panel? As of April 1, 2021, all WellCare of South Carolina Medicaid members will transfer to Absolute Total Care. You now have access to a secure, quick way to electronically settle claims. %%EOF
Refer to your particular provider type program chapter for clarification. 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. (This includes your PCP or another provider.) Pharmacy services prior to April 1, 2021 must be requested from WellCare of South Carolina. All billing requirements must be adher ed to by the provider in order to ensure timely processing of claims. 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. Q. For general questions about claims submissions, call Provider Claims Services at 1-800-575-0418. Keep yourself informed about Coronavirus (COVID-19.) 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 do this: Be sure to ask us to continue your benefits within the 10 calendar day time frame. There is a lot of insurance that follows different time frames for claim submission. Register now. Explains how to receive, load and send 834 EDI files for member information. Do I need to do anything additional to provide services on or after 4/1/2021 if I am in network with both WellCare and Absolute Total Care? For dates of service prior to April 1, 2021: All paper claim submissions can be mailed to: WellCare Health Plans Explains how to receive, load and send 834 EDI files for member information. 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. If Statement Range is March 14, 2021 through April 3, 2021, please send to WellCare. 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 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. Absolute Total Care will honor all existing WellCare authorization approvals that include dates of service beyond March 31, 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. Ancillary Claims Filing Reminders; ClaimsXten TM: Correct Coding Initiative Reference Guide; Inpatient Non-Reimbursable Charges/Unbundling Policy \{-w{,xI202100$0*bZf ,X AayhP3pYla" e 3G& `eoT#@ *;d
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! 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. 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. It was a smart move. 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. 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. You can ask in writing for a State Fair Hearing (hearing, for short). Or it can be made if we take too long to make a care decision. They are called: State law allows you to make a grievance if you have any problems with us. No, Absolute Total Care will continue to operate under the Absolute Total Care name. If an authorization is needed, you can log in to the Secure Provider Portal at absolutetotalcare.com to submit and confirm authorizations. 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. 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 dates of service prior to April 1, 2021 should be filed to WellCare of South Carolina. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. 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. BlueCross BlueShield of South Carolina Piedmont Service Center P.O. To do so by phone, call Member Services at 1-888-588-9842 (TTY1-877-247-6272). This gives members time to establish with a new provider in the network and ensure that they have continuity of care. 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. 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. 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. Contact Us Y0020_WCM_100876E Last Updated On: 10/1/2022 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. Exceptions to the one-year time limit: a) Medicare Cost Sharing Claims . Earliest From Dates on or after April 1, 2021 should be filed to Absolute Total Care. Kasapulam ti tulong? Providers interested in joining the Absolute Total Care Provider Network should submit a request to Network Development and Contracting via email at. Shop or Enroll in a Plan Frequently Asked Questions Find a Doctor Download Digital ID Card Welcome Allwell Members! By continuing to use our site, you agree to our Privacy Policy and Terms of Use. Will Absolute Total Care continue to offer Medicare and Marketplace products? An appeal is a request you can make when you do not agree with a decision we made about your care. In South Carolina, WellCare and Absolute Total Care are joining to better serve you. Pregnant members receiving care from an out-of-network Obstetrician can continue to see their current obstetrician until after the baby is born. Initial Claims: 120 Days from the Date of Service. If you file a grievance or an appeal, we must be fair. 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. Here you will find the tools and resources you need to help manage your submission of claims and receipt of payments. As of April 1, 2021, WellCare will no longer be a separate plan option offered by South Carolina Healthy Connections Choices. Claims for services prior to April 1, 2021 should be filed to WellCare for processing. Professional and Institutional Encounter EDI transactions should be submitted to WellCare of South Carolina Medicaid with Payer ID 59354. The annual flu vaccine helps prevent the flu.Protect yourself and those around you. You can also have a video visit with a doctor using your phone or computer. 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. As of April 1, 2021, all WellCare of South Carolina Medicaid members will become Absolute Total Care members. A. 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. Copyright 2023 Wellcare Health Plans, Inc. State Health Plan State Claims P.O. This includes providing assistance with accessing interpreter services and hearing impaired . However, as of April 1, 2021, all WellCare of South Carolina Medicaid members will become Absolute Total Care members. Please use the Earliest From Date. Additionally, WellCare will have a migration section on their provider page at publishing FAQs. From Date Institutional Statement Dates prior to April 1, 2021 should be filed to WellCare of South Carolina. April 1-April 3, 2021, please send to Absolute Total Care. Earliest From Dates prior to April 1, 2021 should be filed to WellCare of South Carolina. The Claim Reconsideration process is an informal claim review, and is not a substitute for an appeal of a final agency decision. 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. 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. What will happen to unresolved claims prior to the membership transfer? Earliest From Dates prior to 4/1/2021 should be filed to WellCare of South Carolina. Yes, Absolute Total Care and WellCare will continue to offer Medicare products under their current brands and product names, until further notice. Can I continue to see my current WellCare members? DOS April 1, 2021 and after: Processed by Absolute Total Care. Copyright 2023 Wellcare Health Plans, Inc. 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. Explains rules and state, line of business and CMS-specific regulations regarding 837P EDI transactions. Those who attend the hearing include: You can also request to have your hearing over the phone. For dates of service on or after April 1, 2021: Absolute Total Care If at any time you need help filing one, call us. Where should I submit claims for WellCare Medicaid members that transition to Absolute Total Care? Q. Pregnant members receiving care from an out of network Obstetrician can continue to see their current Obstetrician until after the baby is born. Members can continue to receive services from their current WellCare provider as long as they remain covered under WellCare. You may file your second level grievance review within 30 days of receiving your grievance decision letter. To avoid rejections please split the services into two separate claim submissions. As of April 1, 2021 Absolute Total Care, a Centene company, is now the health plan for South Carolina Medicaid members. The second level review will follow the same process and procedure outlined for the initial review. For requests involving dates of service on April 1, 2021 and beyond, Absolute Total Care will follow Medicaid contract requirements allowing a 90-day transition of care period. In this section, we will explain how you can tell us about these concerns/grievances.
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