Want to receive your payments faster to improve cash flow? Please be sure to use the correct line of business prior authorization form for prior authorization requests. 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 can continue to receive services from their current WellCare provider as long as they remain covered under WellCare. As of April 1, 2021, all WellCare of South Carolina Medicaid members will become Absolute Total Care members. Members will receive a 90-day transition of care period if the member is receiving ongoing care and treatment. Incorrect forms will not be considered and may lead to further delays in processing prior authorization requests. WellCare claims will be processed according to timely filing provisions in the providers WellCare Participating Provider Agreement. Claims will be processed according to timely filing provisions in the providers Absolute Total Care Participating Provider Agreement. People of all ages can be infected. We process check runs daily, with the exception of Sundays, National Holidays, and the last day of the month. %%EOF
Pregnant members receiving care from an out-of-network Obstetrician can continue to see their current obstetrician until after the baby is born. The onlineProvider Manual represents the most up-to-date information on Absolute Total Cares Medicaid Plan, programs, policies, and procedures. 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. The benefit can be used to get more than 150 items - including vitamins, pain relievers, cold and allergy medicines, baby wipes, and diapers - at no cost . By continuing to use our site, you agree to our Privacy Policy and Terms of Use. We will send you another letter with our decision within 90 days or sooner. All dates of service on or after April 1, 2021 should be filed to Absolute Total Care. You will need Adobe Reader to open PDFs on this site. 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. 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. Providers are encouraged to sign up to receive EFT payments to avoid any payment delays. 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 WellCare of North Carolina partners with providers to develop and deliver high-quality, cost-effective health care solutions. We may apply a 14 day extension to your grievance resolution. Box 8206 Go365 for Humana Healthy Horizons Members can register for the new Go365 for Humana Healthy Horizons wellness program and earn rewards for participating in healthy activities. 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 Claims for services on or after April 1, 2021 should be filed to Absolute Total Care for processing. 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. Obstetrician care provided by an out-of-network obstetrician will be covered for pregnant members inclusive of postpartum care. hb```b``6``e`~ "@1V
NB, They are called: State law allows you to make a grievance if you have any problems with us. WellCare of South Carolina will be known as Absolute Total Care as of April 1, 2021. 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. All billing requirements must be adher ed to by the provider in order to ensure timely processing of claims. 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. Date of Occurrence/DOSprior toApril 1, 2021: Processed by WellCare. This person has all beneficiary rights and responsibilities during the appeal process. Medicaid Claims Payment Policies Explains rules and state, line of business and CMS-specific regulations regarding 837I EDI transactions. Beginning. Box 31224 The annual flu vaccine helps prevent the flu.Protect yourself and those around you. Learn how you can help keep yourself and others healthy. 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. L]4(f4/pn~YTZSp-5/O*F)e~p:a6o{x8r You can file the grievance yourself. Claims for services on or after April 1, 2021 should be filed to Absolute Total Care for processing. DOS prior to April 1, 2021: Processed by WellCare. Professional and Institutional Encounter EDI transactions should be submitted to WellCare of South Carolina Medicaid with Payer ID 59354. Providers are encouraged to visit the Provider Resources webpagefor manuals, forms, and resources related to claims submission, eligibility, prior authorization, and more. Examples: If Statement Range is March 14, 2021 through April 3, 2021, please send to WellCare. WellCare and Absolute Total Care Medicare plans will continue to operate under current brands, product names and provider contracts, until further notice. 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. 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. We will also send you a letter with our decision within 72 hours from receiving your appeal. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. Members will receive a 90-day transition of care period if the member is receiving ongoing care and treatment. Farmington, MO 63640-3821. WellCare understands that having access to the right tools can help you and your staff streamline day-to-day administrative tasks. 8h} \x p`03
1z`@+`~70 G ~Ws5Puick79,4 ,O5@?O-Gr'|5Oj:v6/` Download the free version of Adobe Reader. Claims will be processed according to timely filing provisions in the providers WellCare Participating Provider Agreement. Explains rules and state, line of business and CMS-specific regulations regarding 837P EDI transactions. Claims submission, correspondence, and contact resources will stay the same for the Medicare line of business. 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 general questions about claims submissions, call Provider Claims Services at 1-800-575-0418. Contact Absolute Total Care Provider Service at1-866-433-6041if youhave questions. Reimbursement Policies Electronic and Paper Claims Submissions; Institutional Claims/Encounter Guides. WellCare claims will be processed according to timely filing provisions in the providers WellCare Participating Provider Agreement. Additionally, WellCare will have a migration section on their provider page at publishing FAQs. To do this: Be sure to ask us to continue your benefits within the 10 calendar day time frame. 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. 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. For dates of service prior to April 1, 2021: All paper claim submissions can be mailed to: WellCare Health Plans Where should I submit claims for WellCare Medicaid members that transition to Absolute Total Care? 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. We would like to help your billing department get your EDI (claims and real time) transactions processed as efficiently as possible. Tampa, FL 33631-3372. An appeal is a request you can make when you do not agree with a decision we made about your care. Professional and Institutional Fee-For-Service EDI transactions should be submitted to WellCare of South Carolina Medicaid with Payer ID 14163. You may do this in writing or in person. A provider can act for a member in hearings with the member's written permission in advance. Copyright 2023 Wellcare Health Plans, Inc. Clinical Laboratory Improvement Amendments (CLIA). Q. WellCare is the health care plan that puts you in control. 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 Or it can be made if we take too long to make a care decision. Our call centers, including the nurse advice line, are currently experiencing high volume. Coronavirus Disease 2019 (COVID-19) causes respiratory illness in people and can spread from person to person. A grievance is when you tell us about a concern you have with our plan. 2) Reconsideration or Claim disputes/Appeals. Professional and Institutional Fee-For-Service EDI transactions should be submitted to WellCare of South Carolina Medicaid with Payer ID 14163. 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. 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. Q. A. Q. Explains how to receive, load and send 834 EDI files for member information. 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 More Information Need help? What will happen to unresolved claims prior to the membership transfer? 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. All dates of service prior to April 1, 2021 should be filed to WellCare of South Carolina. No, Absolute Total Care will continue to operate under the Absolute Total Care name. Check out the Interoperability Page to learn more. Register now at https://www.payspanhealth.com or contact PaySpan at providersupport@payspanhealth.com, or 877-331-7154. A. Learn how you can help keep yourself and others healthy. S< Our toll-free fax number is 1-877-297-3112. 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. Q: What is Absolute Total Cares Transition/Continuity of Care Policy? South Carolina DEPARTMENT OF HEALTH AND HUMAN SERVICES Post Office Box 8206 Columbia, South Carolina 29202-8206 www.scdhhs.gov November 24, 2009 ALL . \{-w{,xI202100$0*bZf ,X AayhP3pYla" e 3G& `eoT#@ *;d
Here are some guides we created to help you with claims filing. Q. If you are unable to view PDFs, please download Adobe Reader. B^E{h#XYQv;[ny3Hha1yx4v.sBy jWacQzyL.kHhwtQ~35!Rh#)p+sj31LcC)4*Z:IWIG@WTD- )n,! P.O. Pregnant members receiving care from an out of network Obstetrician can continue to see their current Obstetrician until after the baby is born. You can ask for a State Fair Hearing after we make our appeal decision. 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 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. Those who attend the hearing include: You can also request to have your hearing over the phone. WellCare Medicare members are not affected by this change. 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). P.O. WellCare offers participating providers EFT and ERA services at no charge through PaySpan Health. 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. Explains how to receive, load and send 834 EDI files for member information. We comply with applicable Federal civil rights laws and do not discriminate on the basis of race, color, national origin, age, sex, or disability. For additional information, questions or concerns, please contact your local Provider Network Management Representative. 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. We expect this process to be seamless for our valued members and there will be no break in their coverage. APPEALS, GRIEVANCES AND PROVIDER DISPUTES. Select Health Claims must be filed within 12 months from the date of service. Utilize interactive health and wellness tools to help you manage conditions, improve your health and save money. Division of Appeals and Hearings Member Appeals (Medical, Behavioral Health, and Pharmacy): You will need Adobe Reader to open PDFs on this site. We must have your written permission before someone can file a grievance for you. you have another option. You must ask within 30 calendar days of getting our decision. Members must have Medicaid to enroll. With the completion of this transaction, we have created a premier healthcare enterprise focused on government-sponsored healthcare programs. All Paper Claim Submissions can be mailed to: WellCare Health Plans They must inform their vendor of AmeriHealth Caritas . and Human Services Box 6000 Greenville, SC 29606. 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. As of April 1, 2021 Absolute Total Care, a Centene company, is now the health plan for South Carolina Medicaid members. Addakam ditoy para kenka. Keep yourself informed about Coronavirus (COVID-19.) How do I determine if a professional or an outpatient bill type institutional submission should be filed to WellCare or Absolute Total Care? These SNP plans provide benefits beyond Original Medicare, and may include transportation to medical appointments and vision exams. The provider needs to contact Absolute Total Care to arrange continuing care. Select your topic and plan and click "Chat Now!" to chat with a live agent! By continuing to use our site, you agree to our Privacy Policy and Terms of Use. The Medicare portion of the agreement will continue to function in its entirety as applicable. WellCare offers participating providers EFT and ERA services at no charge through PaySpan Health. Claim Filing Manual - First Choice by Select Health of South Carolina DOS prior toApril 1, 2021: Processed by WellCare. You can make three types of grievances. We have licensed clinicians available to speak with you and to connect you to the support you need to feel better. 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.
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