Additionally, WellCare will have a migration section on their provider webpage publishing FAQs. Q. Timely filing limits vary. 3) Coordination of Benefits. Please be sure to use the correct line of business prior authorization form for prior authorization requests. Absolute Total Care will continue to offer Marketplace products under the Ambetter brand. This manual sets forth the policies and procedures that providers participating in the Wellcare Prime network are required to follow. 1,flQ*!WLOmsmz\D;I5BI,yA#z!vYQi5'fedREF40
b666q1(UtUJJ.i` (T/@E 2023 Medicare and PDP Compare Plans and Enroll Now. 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. The Medicare portion of the agreement will continue to function in its entirety as applicable. You will get a letter from us when any of these actions occur. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. 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). A. This gives members time to establish with a new provider in the network and ensure that they have continuity of care. 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. 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. From Date Institutional Statement Dates on or after April 1, 2021 should be filed to Absolute Total Care. Refer to your particular provider type program chapter for clarification. 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. When you receive your notification of WellCares grievance resolution, and you are dissatisfied with the resolution regarding adverse decisions that affect your ability to receive benefits, access to care, access to services or payment for care of services, you may request a second level review with WellCare. WellCare Medicaid members migrating to Absolute Total Care will be assigned to their assigned WellCare primary care provider as if the primary care provideris in network with Absolute Total Care. They are called: State law allows you to make a grievance if you have any problems with us. For dates of service prior to April 1, 2021: All paper claim submissions can be mailed to: WellCare Health Plans We will notify you orally and in writing. This gives members time to establish with a new provider in the network and ensure that they have continuity of care. Explains rules and state, line of business and CMS-specific regulations regarding 837P EDI transactions. Providers FAQs | Wellcare You, your friend, a relative, legal counsel or other spokesperson who has your written consent may ask for a State Fair Hearing. We will continue covering your medical services during your appeal request and State Fair Hearing if all of the following are meet. 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. Providers interested in joining the Absolute Total Care Provider Network should submit a request to Network Development and Contracting via email at. South Carolina | Wellcare 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 Additionally, WellCare will have a migration section on their provider page at publishing FAQs. 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. WellCare Medicare members are not affected by this change. 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? 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. 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. Welcome to WellCare of South Carolina! 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. 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. We are committed to improving the quality of life of our millions of members, who often include some of our nations most vulnerable populations. Or you can have someone file it for you. However, as of April 1, 2021, all WellCare of South Carolina Medicaid members will become Absolute Total Care members. WellCare claims will be processed according to timely filing provisions in the providers WellCare Participating Provider Agreement. 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. 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. 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. Finding a doctor is quick and easy. Q. Box 3050 You can ask in writing for a State Fair Hearing (hearing, for short). pst/!+ Y^Ynwb7tw,eI^ 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. 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. As of April 1, 2021, all WellCare of South Carolina Medicaid members will become Absolute Total Care members. We expect this process to be seamless for our valued members and there will be no break in their coverage. For example, if a payer has a 90-day timely filing requirement, that means you need to submit the claim within 90 days of the date of service. The provider needs to contact Absolute Total Care to arrange continuing care. Absolute Total Care will continue to offer Marketplace products under the Ambetter brand. 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. 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. As of April 1, 2021, all WellCare of South Carolina Medicaid members will transfer to Absolute Total Care. Here are some guides we created to help you with claims filing. These materials are for informational purposes only. Download the free version of Adobe Reader. 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. Providers can help facilitate timely claim payment by having an understanding of our processes and requirements. Please use the earliest From Date. WellCare understands that having access to the right tools can help you and your staff streamline day-to-day administrative tasks. An appeal may be filed within 60 calendar days from the date on the Adverse Benefit Determination Notice. Providers interested in joining the Absolute Total Care Provider Network should submit a request to Network Development and Contracting via email at atc_contracting@centene.com. Providers interested in joining the Absolute Total Care vision network for routine vision services can contact Envolve Vision at 1-800-531-2818. N .7$* P!70 *I;Rox3
] LS~. Our fax number is 1-866-201-0657. WellCare of South Carolina will be known as Absolute Total Care as of April 1, 2021. 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. Q. PROVIDER REMINDER: It is important that providers check eligibility prior to providing services as members can potentially change plans prior to 4/1/2021 if they are in the annual choice period. 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. DOS prior toApril 1, 2021: Processed by WellCare. For standard requests, if you call in your appeal, you must follow up with a written, signed one, within thirty calendar days. 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. With the completion of this transaction, we have created a premier healthcare enterprise focused on government-sponsored healthcare programs. Claim Reconsideration Policy-Fee For Service (FFS) Medicaid Q. How do I determine if a professional or an outpatient bill type institutional submission should be filed to WellCare or Absolute Total Care? A. WellCare of South Carolina will be known as Absolute Total Care as of April 1, 2021. You can also have a video visit with a doctor using your phone or computer. You or your authorized representative will tell the hearing officer why you think we made the wrong decision. 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? South Carolina Department of Health and Human Services Division of Appeals and Hearings P.O. DOSApril 1, 2021 and after: Processed by Absolute Total Care. You can make three types of grievances. No, Absolute Total Care will continue to operate under the Absolute Total Care name. At the hearing, well explain why we made our decision. Or it can be made if we take too long to make a care decision. 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. Register now at https://www.payspanhealth.com or contact PaySpan at providersupport@payspanhealth.com, or 877-331-7154. 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. Q. The participating provider agreement with WellCare will remain in-place after April 1, 2021. Pregnant members receiving care from an out of network Obstetrician can continue to see their current Obstetrician until after the baby is born. Providers can help facilitate timely claim payment by having an understanding of our processes and requirements. All dates of service on or after April 1, 2021 should be filed to Absolute Total Care. WellCare of South Carolinawants to ensure that claims are handled as efficiently as possible. 1071 0 obj
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How are WellCare Medicaid member authorizations being handled after April 1, 2021? However, there will be no members accessing/assigned to the Medicaid portion of the agreement. If you are unable to view PDFs, please download Adobe Reader. 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. A. Provider Manuals and Forms | Absolute Total Care Claims and billing - Select Health of SC you have another option. Box 600601 Columbia, SC 29260. 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. The hearing officer will decide whether our decision was right or wrong. Federal Employee Program (FEP) Federal Employee Program P.O. Claims for services on or after April 1, 2021 should be filed to Absolute Total Care for processing. Additionally, WellCare will have a migration section on their provider page at publishing FAQs. State Health Plan State Claims P.O. 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 April 1, 2021. Medicaid North Carolina | Healthy Blue of North Carolina Attn: Grievance Department First Choice can accept claim submissions via paper or electronically (EDI). P.O. You can file a grievance by calling or writing to us. Absolute Total Care will honor all existing WellCare authorization approvals that include dates of service beyond March 31, 2021. Need an account? Appeals and Grievances | Wellcare The way your providers or others act or treat you. To write us, send mail to: You can fax it too. All dates of service prior to 4/1/2021 should be filed to WellCare of South Carolina. 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 With the completion of this transaction, we have created a premier healthcare enterprise focused on government-sponsored healthcare programs. 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. Q. 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.
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