We are simplifying Medicare so you can choose and use an affordable local plan that will help you achieve your best possible health. 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. 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. 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. 941w*)bF iLK\c;nF mhk} 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. Ambetter from Absolute Total Care - South Carolina. We comply with applicable Federal civil rights laws and do not discriminate on the basis of race, color, national origin, age, sex, or disability. Examples of good cause include, but are not limited to, the following: We will send you a letter within five business days of getting your appeal. A. S< 0 We will review it and send you a decision letter within 30 calendar days from receiving your appeal. Claims submission, correspondence, and contact resources will stay the same for the Medicare line of business. Outpatient Prior Authorization Form (PDF) Inpatient Prior Authorization Form (PDF) 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. State Health Plan State Claims P.O. What is the Rx BIN and Group Number for WellCare members transitioning to Absolute Total Care on April 1, 2021? 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. A. Need an account? Professional and Institutional Fee-For-Service EDI transactions should be submitted to WellCare of South Carolina Medicaid with Payer ID 14163. Learn how you can help keep yourself and others healthy. To do this: Be sure to ask us to continue your benefits within the 10 calendar day time frame. WellCare and Absolute Total Care Medicare plans will continue to operate under current brands, product names and provider contracts, until further notice. A. WellCare of South Carolina will be known as Absolute Total Care as of April 1, 2021. 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. What will happen to my Participating Provider Agreement with WellCare after 4/1/2021? You can also have a video visit with a doctor using your phone or computer. 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. Q. They must inform their vendor of AmeriHealth Caritas . Earliest From Dates on or after 4/1/2021 should be filed to Absolute Total Care. 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. Will my existing WellCare patients be assigned to my Absolute Total Care Panel? Members can continue to receive services from their current WellCare provider as long as they remain covered under WellCare. 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 A. We want to ensure that claims are handled as efficiently as possible. However, as of April 1, 2021, all WellCare of South Carolina Medicaid members will become Absolute Total Care members. DOS prior to April 1, 2021: Processed by WellCare. We are proud to announce that WellCare is now part of the Centene Family. 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 Explains rules and state, line of business and CMS-specific regulations regarding 837P EDI transactions. Explains how to receive, load and send 834 EDI files for member information. 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. Will Absolute Total Care change its name to WellCare? Q. Select your topic and plan and click "Chat Now!" to chat with a live agent! 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. z4M0(th`1Lf`M18c BIcJ[%4l JU2 _ s WellCare has partnered with Change Healthcare as our preferred EDI Clearinghouse. 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. South Carolina Department of Health and Human Services Division of Appeals and Hearings P.O. Q. You or your provider must call or fax us to ask for a fast appeal. Our health insurance programs are committed to transforming the health of the community one individual at a time. The Medicare portion of the agreement will continue to function in its entirety as applicable. With the completion of this transaction, we have created a premier healthcare enterprise focused on government-sponsored healthcare programs. Date of Occurrence/DOSApril 1, 2021 and after: Processed by Absolute Total Care. 1044 0 obj <> endobj An appeal may be filed within 60 calendar days from the date on the Adverse Benefit Determination Notice. Division of Appeals and Hearings P.O. You can ask in writing for a State Fair Hearing (hearing, for short). If you are unable to view PDFs, please download Adobe Reader. We will give you information to help you get the most from your benefits and the services we provide. Written notice is not needed if your expedited appeal request is filed verbally. An appeal is a request you can make when you do not agree with a decision we made about your care. 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. Download the free version of Adobe Reader. Forms. We cannot disenroll you from our plan or treat you differently. Timely filing limits vary. Q. Q. Professional and Institutional Encounter EDI transactions should be submitted to WellCare of South Carolina Medicaid with Payer ID 59354. The hearing officer will decide whether our decision was right or wrong. If you think you might have been exposed, contact a doctor immediately. Providers are encouraged to visit the Provider Resources webpagefor manuals, forms, and resources related to claims submission, eligibility, prior authorization, and more. The provider needs to contact Absolute Total Care to arrange continuing care. Provider can't require members to appoint them as a condition of getting services. How will credentialing/recredentialing be handled by Absolute Total Care if a provider was recently credentialed/recredentialed by WellCare? APPEALS, GRIEVANCES AND PROVIDER DISPUTES. An authorized representative is someone you select to act on the behalf of a member to assist them through the appeals process. Medicaid Claims Payment Policies 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. At the hearing, well explain why we made our decision. Thanka kaa yoa Tufrbeau ingsnh ngetfu South Caralaita nouMa mpvd. A. WellCare credentialing cycles will be shared with Absolute Total Care in order to reduce duplicative credentialing in the future. 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 interested in joining the Absolute Total Care Provider Network should submit a request to Network Development and Contracting via email at. You can file an appeal if you do not agree with our decision. Contact Us Y0020_WCM_100876E Last Updated On: 10/1/2022 Welcome to WellCare Provider Login Contact Us Join Our Network Medicaid Medicare Tools News and Education AcariaHealth Specialty Pharmacy Pharmacy Forms Request for Drug Coverage Request to Review Drug Coverage Denial . 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. Check out the Interoperability Page to learn more. No, Absolute Total Care will continue to operate under the Absolute Total Care name. Those who attend the hearing include: You can also request to have your hearing over the phone. All dates of service on or after 4/1/2021 should be filed to Absolute Total Care. The state has also helped to set the rules for making a grievance. Q. Obstetrician care provided by an out-of-network obstetrician will be covered for pregnant members inclusive of postpartum care. 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. 2023 Medicare and PDP Compare Plans and Enroll Now. 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? and Human Services 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. 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. We will continue covering your medical services during your appeal request and State Fair Hearing if all of the following are meet. Box 100605 Columbia, SC 29260. From Date Institutional Statement Dates prior to April 1, 2021 should be filed to WellCare of South Carolina. Columbia, SC 29202-8206. UnitedHealthcare Dual Complete Special Needs Plan UnitedHealthcare Dual Complete Special Needs Plans (SNP) offer benefits for people with both Medicare and Medicaid. Please use the Earliest From Date. 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 You, your friend, a relative, legal counsel or other spokesperson who has your written consent may ask for a State Fair Hearing. WellCare claims will be processed according to timely filing provisions in the providers WellCare Participating Provider Agreement. The rules include what we must do when we get a grievance. You can file your appeal by calling or writing to us. As of April 1, 2021, all WellCare of South Carolina Medicaid members will become Absolute Total Care members. If your services are continued during an appeal or a hearing, you can keep getting them until: If the hearing is decided in your favor, well approve and pay for the care that is needed. You can make three types of grievances. Utilize interactive health and wellness tools to help you manage conditions, improve your health and save money. To have someone represent you, you must complete an Appointment of Representative (AOR) form. 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. WellCare understands that having access to the right tools can help you and your staff streamline day-to-day administrative tasks. Earliest From Dates on or after April 1, 2021 should be filed to Absolute Total Care. The annual flu vaccine helps prevent the flu.Protect yourself and those around you. From Date Institutional Statement Dates on or after 4/1/2021 should be filed to Absolute Total Care. DOS April 1, 2021 and after: Processed by 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. Wellcare uses cookies. This includes providing assistance with accessing interpreter services and hearing impaired . Exceptions to the one-year time limit: a) Medicare Cost Sharing Claims . 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. A. If you ask for a fast appeal and we decide that one is not needed, we will: You or your authorized representative can give us more information if you think itll help your appeal (regular or fast). Our fax number is 1-866-201-0657. It will let you know we received your appeal. 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. 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. Where should I submit claims for WellCare Medicaid members? Addakam ditoy para kenka. Within five business days of getting your grievance, we will mail you a letter. Explains rules and state, line of business and CMS-specific regulations regarding 837I EDI transactions. Q. Please contact our Provider Services Call Center at 1-888-898-7969. 837 Institutional Encounter 5010v Guide Initial Claims: 120 Days from the Date of Service. Q. ?-}++lz;.0U(_I]:3O'~3-~%-JM Section 1: General Information. As of April 1, 2021, WellCare will no longer be a separate plan option offered by South Carolina Healthy Connections Choices. 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. We expect this process to be seamless for our valued members, and there will be no break in their coverage. Copyright 2023 Wellcare Health Plans, Inc. Clinical Laboratory Improvement Amendments (CLIA). 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. 3) Coordination of Benefits. You can get many of your Coronavirus-related questions answered here. Members will receive a 90-day transition of care period if the member is receiving ongoing care and treatment. The way your providers or others act or treat you.
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