Members can continue to receive services from their current WellCare provider as long as they remain covered under WellCare. S< P.O. 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. WellCare understands that having access to the right tools can help you and your staff streamline day-to-day administrative tasks. Symptoms are flu-like, including: Fever Coughing Professional and Institutional Fee-For-Service EDI transactions should be submitted to WellCare of South Carolina Medicaid with Payer ID 14163. What is UnitedHealthcare timely filing limit? - Sage-Answer Select Health Claims must be filed within 12 months from the date of service. To write us, send mail to: You can fax it too. WellCare of North Carolina Medicaid providers are not required to obtain an authorization for professional services for the 90-day post-go live period from July 1, 2021 through September 28, 2021. Q. 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. 941w*)bF iLK\c;nF mhk} WellCare and Absolute Total Care Medicare plans will continue to operate under current brands, product names and provider contracts, until further notice. 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. Those who attend the hearing include: You can also request to have your hearing over the phone. Examples: If Statement Range is March 14, 2021 through April 3, 2021, please send to WellCare. Providers do not need to do anything additional to provide services on or after April 1, 2021 if the provider is in network with both WellCare and Absolute Total Care. A. (This includes your PCP or another provider.) 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. You can ask in writing for a State Fair Hearing (hearing, for short). endstream endobj startxref 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. $8v + Yu @bAD`K@8m.`:DPeV @l 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. Appeals and Grievances | Wellcare Explains rules and state, line of business and CMS-specific regulations regarding 837P EDI transactions. 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. We will also send you a letter with our decision within 72 hours from receiving your appeal. If you request a hearing, the request must: A State Fair Hearing is a legal proceeding. As of April 1, 2021 Absolute Total Care, a Centene company, is now the health plan for South Carolina Medicaid members. 3) Coordination of Benefits. WellCare of North Carolina will begin to release medical payments to providers beginning July 6, 2021. Claims Guides | BlueCross BlueShield of South Carolina If at any time you need help filing one, call us. Finding a doctor is quick and easy. Instructions on how to submit a corrected or voided claim. PDF All Medicaid Bulletin - Sc Dhhs Earliest From Dates on or after April 1, 2021 should be filed to Absolute Total Care. This person has all beneficiary rights and responsibilities during the appeal process. People of all ages can be infected. 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. Please use the From Date Institutional Statement Date. Explains how to receive, load and send 834 EDI files for member information. To avoid rejections please split the services into two separate claim submissions. 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. Q. WellCare is the health care plan that puts you in control. You, your friend, a relative, legal counsel or other spokesperson who has your written consent may ask for a State Fair Hearing. From Date Institutional Statement Dates on or after April 1, 2021 should be filed to Absolute Total Care. Box 100605 Columbia, SC 29260. Claims submission, correspondence, and contact resources will stay the same for the Medicare line of business. Copyright 2023 Wellcare Health Plans, Inc. South Carolina Medicaid Provider Resource Guide - WellCare 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. Farmington, MO 63640-3821. Wellcare uses cookies. For dates of service prior to April 1, 2021: All paper claim submissions can be mailed to: WellCare Health Plans 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. Awagandakami DOSApril 1, 2021 and after: Processed by Absolute Total Care. However, as of April 1, 2021, all WellCare of South Carolina Medicaid members will become Absolute Total Care members. 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. We expect this process to be seamless for our valued members and there will be no break in their coverage. If Statement Range is April 2, 2021 through April 10, 2021, please send to Absolute Total Care. Medicaid - Wellcare NC Box 8206 UnitedHealthcare Dual Complete Special Needs Plan UnitedHealthcare Dual Complete Special Needs Plans (SNP) offer benefits for people with both Medicare and Medicaid. It was a smart move. Member Sign-In. We must have your written permission before someone can file a grievance for you. 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. Box 31384 A. Wellcare wants to ensure that claims are handled as efficiently as possible. Timely Filing Beginning October 1, 2020, the Timely Filing submission requirements specified in each Provider's Meridian Medicare contract will be enforced. South Carolina : Login Incorrect forms will not be considered and may lead to further delays in processing prior authorization requests. With the completion of this transaction, we have created a premier healthcare enterprise focused on government-sponsored healthcare programs. Claims and billing - Select Health of SC Q. Box 31224 N .7$* P!70 *I;Rox3 ] LS~. However, there will be no members accessing/assigned to the Medicaid portion of the agreement. 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 DOS prior toApril 1, 2021: Processed by WellCare. Medicaid Claims Payment Policies It can also be about a provider and/or a service. Register now at https://www.payspanhealth.com or contact PaySpan at providersupport@payspanhealth.com, or 877-331-7154. BlueCross BlueShield of South Carolina Piedmont Service Center P.O. We will call you with our decision if we decide you need a fast appeal. Providers are encouraged to visit the Provider Resources webpagefor manuals, forms, and resources related to claims submission, eligibility, prior authorization, and more. Where should I submit claims for WellCare Medicaid members? Box 3050 * Username. 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. First Choice can accept claim submissions via paper or electronically (EDI). Search for primary care providers, hospitals, pharmacies, and more! All dates of service on or after 4/1/2021 should be filed to Absolute Total Care. Providers interested in joining the Absolute Total Care vision network for routine vision services can contact Envolve Vision at 1-800-531-2818. Learn how you can help keep yourself and others healthy. 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. Example of how to properly split claim that span the cutover date of April 1, 2021: Q. 0 Member Appeals (Medical, Behavioral Health, and Pharmacy): You will need Adobe Reader to open PDFs on this site. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. 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. You will receive an acknowledgement letter within 5 business days, and we will send you a resolution within 90 calendar days. DOS April 1, 2021 and after: Processed by Absolute Total Care. Copyright 2023 Wellcare Health Plans, Inc. Claims will be processed according to timely filing provisions in the providers WellCare Participating Provider Agreement. This gives members time to establish with a new provider in the network and ensure that they have continuity of care. A provider can act for a member in hearings with the member's written permission in advance. You or your provider must call or fax us to ask for a fast appeal. 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. 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! The Medicare portion of the agreement will continue to function in its entirety as applicable. Absolute Total Care will honor those authorizations. The Medicare portion of the agreement will continue to function in its entirety as applicable. At WellCare, we value everything you do to deliver quality care to our members your patients and ensure they have a positive health care experience. Wellcare uses cookies. #~0 I Integration FAQs | Absolute Total Care WellCare Medicare members are not affected by this change. Overview & Resources WellCare of North Carolina partners with providers to develop and deliver high-quality, cost-effective health care solutions. The state has also helped to set the rules for making a grievance. The annual flu vaccine helps prevent the flu.Protect yourself and those around you. APPEALS, GRIEVANCES AND PROVIDER DISPUTES. 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. 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. 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. Only you or your authorizedrepresentative can ask for a State Fair Hearing. Q. 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. Timely filing is when you file a claim within a payer-determined time limit. Resources Box 8206 Columbia, SC 29202-8206 Or call 1-800-763-9087. Please use the Earliest From Date. The participating provider agreement with WellCare will remain in-place after 4/1/2021. 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 make sure you ask your members for a copy of their Absolute Total Care and Healthy Connections Choices Medicaid ID cards before each visit. More Information Need help? The annual flu vaccine helps prevent the flu. Wellcare uses cookies. Members can continue to receive services from their current WellCare provider as long as they remain covered under WellCare. Your second-level review will be performed by person(s) not involved in the first review. Date of Occurrence/DOSprior toApril 1, 2021: Processed by WellCare. 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. 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? pst/!+ Y^Ynwb7tw,eI^ A. Download the free version of Adobe Reader. We will send you another letter with our decision within 90 days or sooner. 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. ?-}++lz;.0U(_I]:3O'~3-~%-JM Timely Filing Limit of Insurances - Revenue Cycle Management To do so by phone, call Member Services at 1-888-588-9842 (TTY1-877-247-6272). WellCare credentialing cycles will be shared with Absolute Total Care in order to reduce duplicative credentialing in the future. Members will receive a 90-day transition of care period if the member is receiving ongoing care and treatment. In South Carolina, WellCare and Absolute Total Care are joining to better serve you. Want to receive your payments faster to improve cash flow? Send your written appeal to: We must have your written consent before someone can file an appeal for you. All billing requirements must be adher ed to by the provider in order to ensure timely processing of claims. Claims will be processed according to timely filing provisions in the providers Absolute Total Care Participating Provider Agreement.