Forms. We're here for you. Q: What is Absolute Total Cares Transition/Continuity of Care Policy? Here are some guides we created to help you with claims filing. A. These materials are for informational purposes only. Section 1: General Information. Your second-level review will be performed by person(s) not involved in the first review. PDF Claim Filing Manual - First Choice by Select Health of South Carolina No, Absolute Total Care will continue to operate under the Absolute Total Care name. The hearing officer will decide whether our decision was right or wrong. Claims and billing - Select Health of SC 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. Farmington, MO 63640-3821. As of April 1, 2021, all WellCare of South Carolina Medicaid members will transfer to Absolute Total Care. Medicaid Claims Payment Policies Explains how to receive, load and send 834 EDI files for member information. A. It will let you know we received your appeal. The annual flu vaccine helps prevent the flu. 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. Or it can be made if we take too long to make a care decision. WellCare claims will be processed according to timely filing provisions in the providers WellCare Participating Provider Agreement. WellCare Medicare Advantage Claims must be filed within 180 calendar days from the date of service. 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. They must inform their vendor of AmeriHealth Caritas . Contact Wellcare Prime Provider Service at 1-855-735-4398 if you have questions. If you wish to use a representative, then he or she must complete an Appointment of Representative (AOR) statement. WellCare Medicare members are not affected by this change. 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 We have licensed clinicians available to speak with you and to connect you to the support you need to feel better. %%EOF 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. All dates of service prior to 4/1/2021 should be filed to WellCare of South Carolina. Download the free version of Adobe Reader. Guides Filing Claims with WellCare. Exceptions to the one-year time limit: a) Medicare Cost Sharing Claims . A hearing officer from the State will decide if we made the right decision. 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. Integration FAQs | Absolute Total Care From Date Institutional Statement Dates prior to 4/1/2021 should be filed to WellCare of South Carolina. This gives members time to establish with a new provider in the network and ensure that they have continuity of care. More Information Need help? Date of Occurrence/DOSprior toApril 1, 2021: Processed by WellCare. WellCare Offers New Over-The-Counter Benefit To Its South Carolina 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. The materials located on our website are for dates of service prior to April 1, 2021. Search for primary care providers, hospitals, pharmacies, and more! 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. 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. S< 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. From Date Institutional Statement Dates on or after 4/1/2021 should be filed to Absolute Total 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. You or your authorized representative will tell the hearing officer why you think we made the wrong decision. As of April 1, 2021 Absolute Total Care, a Centene company, is now the health plan for South Carolina Medicaid members. 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 can also be about a provider and/or a service. 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 Will WellCare continue to offer current products or Medicare only? Federal Employee Program (FEP) Federal Employee Program P.O. P.O. Know the facts about Coronavirus (COVID-19) Our call centers, including the nurse advice line, are currently experiencing high volume. 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. 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. Utilize interactive health and wellness tools to help you manage conditions, improve your health and save money. Professional and Institutional Fee-For-Service EDI transactions should be submitted to WellCare of South Carolina Medicaid with Payer ID 14163. We want to ensure that claims are handled as efficiently as possible. Providers interested in joining the Absolute Total Care vision network for routine vision services can contact Envolve Vision at 1-800-531-2818. A. We will notify you orally and in writing. Earliest From Dates prior to 4/1/2021 should be filed to WellCare of South Carolina. WellCare and Absolute Total Care Medicare plans will continue to operate under current brands, product names and provider contracts, until further notice. 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. 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 P.O. Ambetter from Absolute Total Care - South Carolina. Absolute Total Care will continue to offer Marketplace products under the Ambetter brand. State Health Plan State Claims P.O. However, there will be no members accessing/assigned to the Medicaid portion of the agreement. Members will receive a 90-day transition of care period if the member is receiving ongoing care and treatment. 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. We are proud to announce that WellCare is now part of the Centene Family. To do so by phone, call Member Services at 1-888-588-9842 (TTY1-877-247-6272). Addakam ditoy para kenka. As of April 1, 2021, all WellCare of South Carolina Medicaid members will transfer to Absolute Total Care. 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. The Medicare portion of the agreement will continue to function in its entirety as applicable. 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. \{-w{,xI202100$0*bZf ,X AayhP3pYla" e 3G& `eoT#@ *;d For the latest COVID-19 news, visit the CDC. 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. Q. You may do this in writing or in person. Instructions on how to submit a corrected or voided claim. 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. To avoid rejections please split the services into two separate claim submissions. Claims for services on or after April 1, 2021 should be filed to Absolute Total Care for processing. WellCare has partnered with Change Healthcare as our preferred EDI Clearinghouse. 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. Farmington, MO 63640-3821. A. Home | Wellcare WellCare credentialing cycles will be shared with Absolute Total Care in order to reduce duplicative credentialing in the future. A. We are proud to announce that WellCare is now part of the Centene Family. Timely Filing Limits - Health Network Solutions South Carolina Medicaid Provider Documents - Humana Professional and Institutional Encounter EDI transactions should be submitted to WellCare of South Carolina Medicaid with Payer ID 59354. Members will need to talk to their provider right away if they want to keep seeing him/her. Will Absolute Total Care continue to offer Medicare and Marketplace products? * Password. 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. For dates of service prior to April 1, 2021: All paper claim submissions can be mailed to: WellCare Health Plans Payments mailed to providers are subject to USPS mailing timeframes. A. We cannot disenroll you from our plan or treat you differently. Members will receive a 90-day transition of care period if the member is receiving ongoing care and treatment. However, as of April 1, 2021, all WellCare of South Carolina Medicaid members will become Absolute Total Care members. Wellcare Health Plans, Inc., complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. 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. 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 dates of service on or after April 1, 2021: Absolute Total Care For standard requests, if you call in your appeal, you must follow up with a written, signed one, within thirty calendar days. Electronic and Paper Claims Submissions; Institutional Claims/Encounter Guides. 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. This must be done within 120 days from the date of Notice of Appeal Resolution you received from us. In this section, we will explain how you can tell us about these concerns/grievances. Q. People of all ages can be infected. WellCare of South Carolina will be known as Absolute Total Care as of April 1, 2021. Symptoms are flu-like, including: Fever Coughing The participating provider agreement with WellCare will remain in-place after 4/1/2021. WellCare and Absolute Total Care Medicare plans will continue to operate under current brands, product names and provider contracts, until further notice. Q. However, there will be no members accessing/assigned to the Medicaid portion of the agreement. Beginning, March 14 March 31, 2021, please send to WellCare, April 1 April 3, 2021, please send to Absolute Total Care, DOS prior to 4/1/2021- Processed by WellCare, DOS 4/1/2021 and after- Processed by Absolute Total Care, Date of Occurrence/DOS prior to 4/1/2021- Processed by WellCare, Date of Occurrence/DOS 4/1/2021 and after- Processed by Absolute Total Care. Resources 2) Reconsideration or Claim disputes/Appeals. Please use the From Date Institutional Statement Date. The rules include what we must do when we get a grievance. Tampa, FL 33631-3372. Box 8206 Columbia, SC 29202-8206 Or call 1-800-763-9087. APPEALS, GRIEVANCES AND PROVIDER DISPUTES. A. With the completion of this transaction, we have created a premier healthcare enterprise focused on government-sponsored healthcare programs. Copyright 2023 Wellcare Health Plans, Inc. 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. We process check runs daily, with the exception of Sundays, National Holidays, and the last day of the month. 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. 1096 0 obj <>stream What is the Rx BIN and Group Number for WellCare members transitioning to Absolute Total Care on April 1, 2021? To earn rewards, members must: Download the Go365 for Humana Healthy Horizons app onto a mobile device from the Apple App Store or Google Play. P.O. To have someone represent you, you must complete an Appointment of Representative (AOR) form. Providers can help facilitate timely claim payment by having an understanding of our processes and requirements. South Carolina Medicaid & Health Insurance | Absolute Total Care 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. N .7$* P!70 *I;Rox3 ] LS~. This person has all beneficiary rights and responsibilities during the appeal process. For general questions about claims submissions, call Provider Claims Services at 1-800-575-0418. Yes, Absolute Total Care and WellCare will continue to offer Medicare products under their current brands and product names, until further notice. 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. Managed Care Claims and Prior Authorizations Submission - NCDHHS Our fax number is 1-866-201-0657. Check out the Interoperability Page to learn more. Timely Filing Beginning October 1, 2020, the Timely Filing submission requirements specified in each Provider's Meridian Medicare contract will be enforced. Explains rules and state, line of business and CMS-specific regulations regarding 837P EDI transactions. That's why we provide tools and resources to help. Box 31384 From Date Institutional Statement Dates prior to April 1, 2021 should be filed to WellCare of South Carolina. P.O. Timely Filing Limits for all Insurances updated (2023) 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 FAQs | Wellcare 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. 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. 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). Attn: Grievance Department Initial Claims: 120 Days from the Date of Service. Explains how to receive, load and send 834 EDI files for member information. Welcome to WellCare of South Carolina! All dates of service on or after April 1, 2021 should be filed to Absolute Total Care. 1,flQ*!WLOmsmz\D;I5BI,yA#z!vYQi5'fedREF40 b666q1(UtUJJ.i` (T/@E Or you can have someone file it for you. 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. If Statement Range is March 14, 2021 through April 3, 2021, please send to WellCare. Box 31224 Explains how to receive, load and send 834 EDI files for member information. Copyright 2023 Wellcare Health Plans, Inc. Clinical Laboratory Improvement Amendments (CLIA). 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. Claims will be processed according to timely filing provisions in the providers Absolute Total Care Participating Provider Agreement. WellCare offers participating providers EFT and ERA services at no charge through PaySpan Health. A. As of April 1, 2021, all WellCare of South Carolina Medicaid members will become Absolute Total Care members. The state has also helped to set the rules for making a grievance. 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. Only you or your authorizedrepresentative can ask for a State Fair Hearing. Register now at https://www.payspanhealth.com or contact PaySpan at providersupport@payspanhealth.com, or 877-331-7154. No, Absolute Total Care will continue to operate under the Absolute Total Care name. Member Appeals (Medical, Behavioral Health, and Pharmacy): You will need Adobe Reader to open PDFs on this site. However, there will be no members accessing/assigned to the Medicaid portion of the agreement. endstream endobj startxref We will do this as quickly as possible as but no longer than 72-hours from the decision. Our toll-free fax number is 1-877-297-3112. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. Q. Synagis (RSV) - Medical Benefit or Retail Pharmacy, 17P or Makena - Medical Benefit or Retail Pharmacy, Special Supplemental Benefits for Chronically Ill (SSBCI), Screening, Brief Intervention, and Referral to Treatment (SBIRT), Patient Centered Medical Home Model (PCMH), Healthcare Effectiveness Data and Information Set (HEDIS), Consumer Assessment of Healthcare Providers and Systems (CAHPS), National Committee for Quality Assurance (NCQA), Hurricane Florence: What You Need to Know, Absolute Total Care Payment Policy and Edit Updates Effective 5/1/21, Notice About a New Payment Integrity Audit Program, Absolute Total Care Updated Guidance for Medicaid BabyNet Therapy Providers, Wellcare By Allwell Changing Peer-to-Peer Review Request and Elective Inpatient Prior Authorization Requirements for Medicare Advantage Plans, NEW Attestation Process for Special Supplemental Benefits for Chronically Ill (SSBCI), Medicare Prior Authorization Change Summary - Effective 1/1/2023, Shortened Notification of Pregnancy (NOP) Provider Form (PDF), Notification of Pregnancy (NOP) Provider Form (PDF), Pregnancy Incentive Reimbursement Form (PDF), SCDHHS Form 1716 - Request for Medicaid ID Number - Infant (PDF), Member Appointment of Authorized Representative Form (PDF), SCDHHS Hospice Election/Enrollment Forms (PDF), Inpatient Prior Authorization Fax Form (PDF), Outpatient Prior Authorization Fax Form (PDF), SCDHHS Certificate of Medical Necessity (CMN) for Oxygen (PDF), Sick and Well Visit Reimbursement Letter (PDF), Claim Adjustments, Reconsiderations, and Disputes Provider Education (PDF), Obstetrical (OB) Incentive Programs (PDF), Provider Portal Enhancements: Claim Reconsideration and Denial Explanations (PDF), Outpatient Prior Authorization Form (PDF), Medicare Prescription Drug Coverage Determination Form (PDF), Authorization to Use and/or Disclose Health Information (PDF), Revocation of Authorization to Use and/or Disclose Health Information (PDF), Behavioral Health Psychological or Neuropsychological Testing Authorization Request Form (PDF), Electroconvulsive Therapy (ECT) Authorization Request Form (PDF), Behavioral Health Outpatient Treatment Request Form (PDF), Transitional Care Management Services Fact Sheet (PDF), Expedited Prior Authorization Request FAQ (PDF), Balance Billing Quick Reference Guide (PDF), 2021 Prior Authorization List Part B Appendix A (PDF), Bi-Annual Prior Authorization Update (PDF), 2021 Bi-Annual Prior Authorization Update Effective 8/1/21 (PDF), 2021 List of Covered Drugs (Formulary) Changes (PDF), New Century Health Implementation Notification (PDF), 2022 Wellcare by Allwell Provider Manual (PDF), Provider Reconsideration/Dispute Form (PDF), Behavioral Health Neuropsychological Testing Authorization Request Form (PDF), Behavioral Health Outpatient Treatement Request Form (PDF), Behavioral Health Electroconvulsive Therapy (ECT) Authorization Request Form (PDF), Electronic Funds Transfer (ETF) Features (PDF), 2021 List of Covered Drugs (Formulary) DSNP Changes (PDF), 2021 List of Covered Drugs (Formulary) HMO Changes (PDF).

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