Want to receive your payments faster to improve cash flow? You will have a limited time to submit additional information for a fast appeal. 1,flQ*!WLOmsmz\D;I5BI,yA#z!vYQi5'fedREF40 b666q1(UtUJJ.i` (T/@E It will let you know we received your appeal. 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. Farmington, MO 63640-3821. 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. Please be sure to use the correct line of business prior authorization form for prior authorization requests. People of all ages can be infected. Within five business days of getting your grievance, we will mail you a letter. 837 Institutional Encounter 5010v Guide 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. 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. If Statement Range is March 14, 2021 through April 3, 2021, please send to WellCare. Earliest From Dates prior to April 1, 2021 should be filed to WellCare of South Carolina. There is a lot of insurance that follows different time frames for claim submission. For additional information, questions or concerns, please contact your local Provider Network Management Representative. We process check runs daily, with the exception of Sundays, National Holidays, and the last day of the month. 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. Will Absolute Total Care change its name to 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. Earliest From Dates on or after April 1, 2021 should be filed to Absolute Total Care. 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. Providers interested in joining the Absolute Total Care Provider Network should submit a request to Network Development and Contracting via email at. P.O. Examples: If Statement Range is March 14, 2021 through April 3, 2021, please send to WellCare. DOS prior to April 1, 2021: Processed by WellCare. We understand that maintaining a healthy community starts with providing care to those who need it most. 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). We are simplifying Medicare so you can choose and use an affordable local plan that will help you achieve your best possible health. 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 WellCare Payor ID 14163. A grievance is when you tell us about a concern you have with our plan. Here you will find the tools and resources you need to help manage your submission of claims and receipt of payments. A. WellCare credentialing cycles will be shared with Absolute Total Care in order to reduce duplicative credentialing in the future. Q. 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. No, Absolute Total Care will continue to operate under the Absolute Total Care name. Explains rules and state, line of business and CMS-specific regulations regarding 837P EDI transactions. Columbia, SC 29202-8206. Or it can be made if we take too long to make a care decision. Keep yourself informed about Coronavirus (COVID-19.) and Human Services Member Appeals (Medical, Behavioral Health, and Pharmacy): Copyright 2023 Wellcare Health Plans, Inc. As of April 1, 2021, all WellCare of South Carolina Medicaid members will become Absolute Total Care members. Effective January 1, 2015 the South Carolina Department of Health and Human Services (SCDHHS) will implement a Claim Reconsideration Policy. Hearings are used when you were denied a service or only part of the service was approved. #~0 I Please contact our Provider Services Call Center at 1-888-898-7969. From Date Institutional Statement Dates on or after 4/1/2021 should be filed to Absolute Total Care. WellCare of South Carolina will be known as Absolute Total Care as of April 1, 2021. A. WellCare offers participating providers EFT and ERA services at no charge through PaySpan Health. Providers interested in joining the Absolute Total Care vision network for routine vision services can contact Envolve Vision at 1-800-531-2818. You must ask within 30 calendar days of getting our decision. Date of Occurrence/DOSApril 1, 2021 and after: Processed by Absolute Total Care. A. 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. Please use the From Date Institutional Statement Date. To do so by phone, call Member Services at 1-888-588-9842 (TTY1-877-247-6272). Providers are encouraged to sign up to receive EFT payments to avoid any payment delays. WellCare has partnered with Change Healthcare as our preferred EDI Clearinghouse. Claims will be processed according to timely filing provisions in the providers Absolute Total Care Participating Provider Agreement. WellCare Medicare members are not affected by this change. However, as of April 1, 2021, all WellCare of South Carolina Medicaid members will become Absolute Total Care members. Box 3050 We expect this process to be seamless for our valued members and there will be no break in their coverage. Tampa, FL 33631-3372. For dates of service on or after April 1, 2021: Absolute Total Care 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. All Paper Claim Submissions can be mailed to: WellCare Health Plans Instructions on how to submit a corrected or voided claim. Absolute Total Care will honor those authorizations. 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. Absolute Total Care will honor those authorizations. All dates of service on or after 4/1/2021 should be filed to Absolute Total Care. Q. Providers can help facilitate timely claim payment by having an understanding of our processes and requirements. 1044 0 obj <> endobj P.O. The onlineProvider Manual represents the most up-to-date information on Absolute Total Cares Medicaid Plan, programs, policies, and procedures. Here are some guides we created to help you with claims filing. Section 1: General Information. 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. Those who attend the hearing include: You can also request to have your hearing over the phone. Shop or Enroll in a Plan Frequently Asked Questions Find a Doctor Download Digital ID Card Welcome Allwell Members! If you file a grievance or an appeal, we must be fair. Learn more about how were supporting members and providers. 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. A. Absolute Total Care will continue to offer Marketplace products under the Ambetter brand. You can ask for a State Fair Hearing after we make our appeal decision. Ancillary Claims Filing Reminders; ClaimsXten TM: Correct Coding Initiative Reference Guide; Inpatient Non-Reimbursable Charges/Unbundling Policy 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. 3) Coordination of Benefits. 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. Ambetter from Absolute Total Care - South Carolina. 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. UnitedHealthcare Dual Complete Special Needs Plan UnitedHealthcare Dual Complete Special Needs Plans (SNP) offer benefits for people with both Medicare and Medicaid. We would like to help your billing department get your EDI (claims and real time) transactions processed as efficiently as possible. P.O. 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. Our fax number is 1-866-201-0657. Claim Filing Manual - First Choice by Select Health of South Carolina 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. Register now at https://www.payspanhealth.comor contact PaySpan at providersupport@payspanhealth.com, or 877-331-7154. Members will receive a 90-day transition of care period if the member is receiving ongoing care and treatment. Coronavirus Disease 2019 (COVID-19) causes respiratory illness in people and can spread from person to person. More Information Need help? Guides Filing Claims with WellCare. From Date Institutional Statement Dates prior to April 1, 2021 should be filed to WellCare of South Carolina. 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 can help facilitate timely claim payment by having an understanding of our processes and requirements. You can file an appeal if you do not agree with our decision. Select your topic and plan and click "Chat Now!" to chat with a live agent! Written notice is not needed if your expedited appeal request is filed verbally. Member Appeals (Medical, Behavioral Health, and Pharmacy): You will need Adobe Reader to open PDFs on this site. South Carolina DEPARTMENT OF HEALTH AND HUMAN SERVICES Post Office Box 8206 Columbia, South Carolina 29202-8206 www.scdhhs.gov November 24, 2009 ALL . 8h} \x p`03 1z`@+`~70 G ~Ws5Puick79,4 ,O5@?O-Gr'|5Oj:v6/` Claims for services on or after April 1, 2021 should be filed to Absolute Total Care for processing. How do I bill a professional submission with services spanning before and after 04/01/2021? Professional and Institutional Fee-For-Service EDI transactions should be submitted to WellCare of South Carolina Medicaid with Payer ID 14163. A. For dates of service prior to April 1, 2021: All paper claim submissions can be mailed to: WellCare Health Plans Copyright 2023 Wellcare Health Plans, Inc. 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. 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. Addakam ditoy para kenka. All billing requirements must be adher ed to by the provider in order to ensure timely processing of claims. You and the person you choose to represent you must sign the AOR form. 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. With the completion of this transaction, we have created a premier healthcare enterprise focused on government-sponsored healthcare programs. 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 see list of services that will require authorization during this time. Claims Department Where should I submit claims for WellCare Medicaid members that transition to Absolute Total Care? How do I determine if a professional or an outpatient bill type institutional submission should be filed to WellCare or Absolute Total Care? If you need claim filing assistance, please contact your provider advocate. Need an account? Q. If you dont, we will have to deny your request. Wellcare uses cookies. A. Tampa, FL 33631-3384. This manual sets forth the policies and procedures that providers participating in the Wellcare Prime network are required tofollow. It is 30 days to 1 year and more and depends on . Claims Submission, Correspondence and Contact Resources will stay the same for the Medicare line of business. Box 31224 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. 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. WellCare of North Carolina partners with providers to develop and deliver high-quality, cost-effective health care solutions. Box 100605 Columbia, SC 29260. 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. 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. Members will receive a 90-day transition of care period if the member is receiving ongoing care and treatment. Box 31384 They must inform their vendor of AmeriHealth Caritas . As of April 1, 2021, all WellCare of South Carolina Medicaid members will transfer to Absolute Total Care. DOSApril 1, 2021 and after: Processed by Absolute Total Care. For current information, visit the Absolute Total Care website. You may do this in writing or in person. Box 8206 Columbia, SC 29202-8206 Or call 1-800-763-9087. Please note - a representative may file for a member who: If the members request for appeal is submitted after 60 calendar days from the date on the NABD, then good cause must be shown in order for WellCare to accept the late request. 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? By continuing to use our site, you agree to our Privacy Policy and Terms of Use. You will get a letter from us when any of these actions occur. 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. Claims for services prior to April 1, 2021 should be filed to WellCare for processing. Division of Appeals and Hearings Q. Timely filing limits vary. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. Members will need to talk to their provider right away if they want to keep seeing him/her. \{-w{,xI202100$0*bZf ,X AayhP3pYla" e 3G& `eoT#@ *;d By continuing to use our site, you agree to our Privacy Policy and Terms of Use. South Carolina | Wellcare SOUTH CAROLINA Healthcare done well. %PDF-1.6 % Professional and Institutional Encounter EDI transactions should be submitted to WellCare of South Carolina Medicaid with Payer ID 59354. We welcome Brokers who share our commitment to compliance and member satisfaction. 1096 0 obj <>stream The participating provider agreement with WellCare will remain in-place after 4/1/2021. hbbd``b`$= $ Additionally, WellCare will have a migration section on their provider page at publishing FAQs. Q. We cannot disenroll you from our plan or treat you differently. WellCare of South Carolina will be known as Absolute Total Care as of April 1, 2021. Wellcare uses cookies. Contact Absolute Total Care Provider Service at1-866-433-6041if youhave questions. We will give you information to help you get the most from your benefits and the services we provide. WellCare and Absolute Total Care Medicare plans will continue to operate under current brands, product names and provider contracts, until further notice. However, as of April 1, 2021, all WellCare of South Carolina Medicaid members will become Absolute Total Care members. Box 3050 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. This manual sets forth the policies and procedures that providers participating in the Absolute Total Carenetwork are required tofollow.

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