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. Q. The way your providers or others act or treat you. We are proud to announce that WellCare is now part of the Centene Family. All dates of service prior to April 1, 2021 should be filed to WellCare of South Carolina. Box 3050 ?-}++lz;.0U(_I]:3O'~3-~%-JM Q. 0 Welcome to Wellcare By Allwell, a Medicare Advantage plan. From Date Institutional Statement Dates prior to April 1, 2021 should be filed to WellCare of South Carolina. Q. Section 1: General Information. Instructions on how to submit a corrected or voided claim. WellCare is the health care plan that puts you in control. Members will need to talk to their provider right away if they want to keep seeing him/her. For standard requests, if you call in your appeal, you must follow up with a written, signed one, within thirty calendar days. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. Member Appeals (Medical, Behavioral Health, and Pharmacy): You will need Adobe Reader to open PDFs on this site. We are simplifying Medicare so you can choose and use an affordable local plan that will help you achieve your best possible health. If you need claim filing assistance, please contact your provider advocate. An appeal may be filed within 60 calendar days from the date on the Adverse Benefit Determination Notice. To do so by phone, call Member Services at 1-888-588-9842 (TTY1-877-247-6272). Examples: If Statement Range is March 14, 2021 through April 3, 2021, please send to WellCare. 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. The Medicare portion of the agreement will continue to function in its entirety as applicable. Contact Wellcare Prime Provider Service at 1-855-735-4398 if you have questions. DOS prior toApril 1, 2021: Processed by WellCare. %%EOF B^E{h#XYQv;[ny3Hha1yx4v.sBy jWacQzyL.kHhwtQ~35!Rh#)p+sj31LcC)4*Z:IWIG@WTD- )n,! 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. On June 19, 2018, the Family and Social Services Administration's ("FSSA") Indiana Health Coverage Programs ("IHCP") released provider bulletin BT201829 regarding revising the timely filing limit for Medicaid fee-for-service claims. 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. 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 Learn how you can help keep yourself and others healthy. Appeals and Grievances | Wellcare Earliest From Dates prior to April 1, 2021 should be filed to WellCare of South Carolina. First Choice can accept claim submissions via paper or electronically (EDI). You must ask within 30 calendar days of getting our decision. 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 PDF AmeriHealth Caritas North Carolina Q. Explains rules and state, line of business and CMS-specific regulations regarding 837I EDI transactions. Box 8206 South Carolina Medicaid Provider Documents - Humana For additional information, questions or concerns, please contact your local Provider Network Management Representative. Pregnant members receiving care from an out of network Obstetrician can continue to see their current Obstetrician until after the baby is born. How do I determine if a professional or an outpatient bill type institutional submission should be filed to WellCare or Absolute Total Care? 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 . Please use the From Date Institutional Statement Date. Q. 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. Q. We welcome Brokers who share our commitment to compliance and member satisfaction. The rules include what we must do when we get a grievance. The hearing officer will decide whether our decision was right or wrong. 837 Institutional Encounter 5010v Guide Explains rules and state, line of business and CMS-specific regulations regarding 837P EDI transactions. 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 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. The second level review will follow the same process and procedure outlined for the initial review. State Health Plan State Claims P.O. When to File Claims | Cigna North Carolina PHP Billing Guidance for Local W Code. It was a smart move. You can make three types of grievances. You now have access to a secure, quick way to electronically settle claims. What is the Rx BIN and Group Number for WellCare members transitioning to Absolute Total Care on April 1, 2021? Q. The Claim Reconsideration process is an informal claim review, and is not a substitute for an appeal of a final agency decision. Box 8206 Columbia, SC 29202-8206 Or call 1-800-763-9087. More Information Need help? Absolute Total Care Wfu neebybfgnh bgWfulnybfgC South Carolina Medicaid Provider Resource Guide Thank you for being a star member of our provider team. All billing requirements must be adher ed to by the provider in order to ensure timely processing of claims. P.O. Additionally, WellCare will have a migration section on their provider webpage publishing FAQs. They are called: State law allows you to make a grievance if you have any problems with us. Only you or your authorizedrepresentative can ask for a State Fair Hearing. 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. This gives members time to establish with a new provider in the network and ensure that they have continuity of care. However, there will be no members accessing/assigned to the Medicaid portion of the agreement. Explains how to receive, load and send 834 EDI files for member information. Q. WellCare of South Carolina will be known as Absolute Total Care as of April 1, 2021. Explains rules and state, line of business and CMS-specific regulations regarding 837I EDI transactions. Wellcare uses cookies. 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. If you request a hearing, the request must: A State Fair Hearing is a legal proceeding. Send your written appeal to: We must have your written consent before someone can file an appeal for you. It is called a "Notice of Adverse Benefit Determination" or "NABD." By continuing to use our site, you agree to our Privacy Policy and Terms of Use. South Carolina Department of Health and Human Services Division of Appeals and Hearings P.O. Our toll-free fax number is 1-877-297-3112. WellCare and Absolute Total Care Medicare plans will continue to operate under current brands, product names and provider contracts, until further notice. The participating provider agreement with WellCare will remain in-place after 4/1/2021. 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. Or it can be made if we take too long to make a care decision. As of April 1, 2021, all WellCare of South Carolina Medicaid members will become Absolute Total Care members. Outpatient Prior Authorization Form (PDF) Inpatient Prior Authorization Form (PDF) 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. 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. Claims will be processed according to timely filing provisions in the providers WellCare Participating Provider Agreement. We would like to help your billing department get your EDI (claims and real time) transactions processed as efficiently as possible. We must have your written permission before someone can file a grievance for you. If an authorization is needed, you can log in to the Secure Provider Portalto submit and confirm authorizations. Absolute Total Care will continue to offer Marketplace products under the Ambetter brand. Ancillary Claims Filing Reminders; ClaimsXten TM: Correct Coding Initiative Reference Guide; Inpatient Non-Reimbursable Charges/Unbundling Policy WellCare Medicare Advantage Claims must be filed within 180 calendar days from the date of service. What is UnitedHealthcare timely filing limit? - Sage-Answer Division of Appeals and Hearings 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. If Statement Range is April 2, 2021 through April 10, 2021, please send to Absolute Total Care. P.O. The materials located on our website are for dates of service prior to April 1, 2021. Claims for services on or after April 1, 2021 should be filed to Absolute Total Care for processing. Learn how you can help keep yourself and others healthy. UnitedHealthcare Dual Complete Special Needs Plan UnitedHealthcare Dual Complete Special Needs Plans (SNP) offer benefits for people with both Medicare and Medicaid. This must be done within 120 days from the date of Notice of Appeal Resolution you received from us. Instructions on how to submit a corrected or voided claim. Search for primary care providers, hospitals, pharmacies, and more! you have another option. 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. Earliest From Dates prior to 4/1/2021 should be filed to WellCare of South Carolina. What will happen to my Participating Provider Agreement with WellCare after 4/1/2021? Here are some guides we created to help you with claims filing. Absolute Total Care will honor those authorizations. A. For current information, visit the Absolute Total Care website. Welcome to WellCare of South Carolina! Timely Filing Limit List in Medica Billing (2020 - Medical Billing RCM To have someone represent you, you must complete an Appointment of Representative (AOR) form. This includes providing assistance with accessing interpreter services and hearing impaired . 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. Want to receive your payments faster to improve cash flow? Please use the From Date Institutional Statement Date. Medicaid North Carolina | Healthy Blue of North Carolina 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. 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 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. With quality healthcare solutions, Ambetter from Absolute Total Care helps residents of South Carolina live better. You must file your appeal within 60 calendar days from the date on the NABD. You or your authorized representative will tell the hearing officer why you think we made the wrong decision. Claims - Wellcare NC You will get a letter from us when any of these actions occur. You and the person you choose to represent you must sign the AOR statement. Code of Laws - Title 42 - South Carolina General Assembly Box 31224 PDF Claim Filing Manual - First Choice by Select Health of South Carolina 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. 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. Claims will be processed according to timely filing provisions in the providers Absolute Total Care Participating Provider Agreement. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. A. 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. Professional and Institutional Encounter EDI transactions should be submitted to WellCare of South Carolina Medicaid with Payer ID 59354. Farmington, MO 63640-3821. 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. 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. If an authorization is needed, you can log in to the Secure Provider Portal at absolutetotalcare.com to submit and confirm authorizations. Electronic and Paper Claims Submissions; Institutional Claims/Encounter Guides. As of April 1, 2021, all WellCare of South Carolina Medicaid members will transfer to Absolute Total Care. People of all ages can be infected. If Statement Range is April 2, 2021 through April 10, 2021, please send to Absolute Total Care. 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 healthcare services starting April 1, 2021. As of April 1, 2021, WellCare will no longer be a separate plan option offered by South Carolina Healthy Connections Choices. Visit https://msp.scdhhs.gov/appeals/ to: Copyright 2023 Wellcare Health Plans, Inc. https://msp.scdhhs.gov/appeals/site-page/file-appeal, If we deny or limit a service you or your doctor asks us to approve, If we reduce, suspend or stop services youve been getting that we already approved, If we do not pay for the health care services you get, If we fail to give services in the required timeframe, If we fail to give you a decision in the required timeframe on an appeal you already filed, If we dont agree to let you see a doctor who is not in our network and you live in a rural area or in an area with limited doctors, If you dont agree with a decision we made regarding your medicine, We denied your request to dispute a financial liability, The member did not personally receive the notice of action or received the notice late, The member was seriously ill, which prevented a timely appeal, There was a death or serious illness in the members immediate family, An accident caused important records to be destroyed, Documentation was difficult to locate within the time limits; and/or the member had incorrect or incomplete information concerning the appeals process, Change the appeal to the timeframe for a standard decision (30 calendar days), Follow up with a written letter within 2 calendar days, Tell you over the phone and in writing that you may file a grievance about the denial of the fast appeal request, Be in writing and specify the reason for the request, Include your name, address and phone number, Indicate the date of service or the type of service denied, Your authorized representative (if youve chosen one), A hearing officer from Medicaid and Long-Term Care (MLTC), You or your authorized representative with your written consent must file your appeal with us and ask to continue your benefits within 10 calendar days after we mail the Notice of Adverse benefit determination; or, Within 10 calendar days of the intended effective date of the plans proposed action, whichever is later, The appeal or hearing must address the reduction, suspension or stopping of a previously authorized service, The services were ordered by an authorized provider, The period covered by the original authorization cannot have ended. Obstetrician care provided by an out-of-network obstetrician will be covered for pregnant members inclusive of postpartum care. WellCare credentialing cycles will be shared with Absolute Total Care in order to reduce duplicative credentialing in the future. You can get many of your Coronavirus-related questions answered here. DOS April 1, 2021 and after: Processed by Absolute Total 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. PDF CMS Manual System - Centers for Medicare & Medicaid Services You can file a grievance by calling or writing to us. Reimbursement Policies Ambetter Timely Filing Limit of : 1) Initial Claims. This manual sets forth the policies and procedures that providers participating in the Wellcare Prime network are required to follow. With the completion of this transaction, we have created a premier healthcare enterprise focused on government-sponsored healthcare programs. WellCare of South Carolina will be known as Absolute Total Care as of April 1, 2021. Learn more about how were supporting members and providers. WellCare and Absolute Total Care Medicare plans will continue to operate under current brands, product names and provider contracts, until further notice. At the hearing, well explain why we made our decision. Wellcare uses cookies. WellCare of South Carolina will be known as Absolute Total Care as of April 1, 2021. Coronavirus Disease 2019 (COVID-19) causes respiratory illness in people and can spread from person to person. Claims submission, correspondence, and contact resources will stay the same for the Medicare line of business. South Carolina : Login Refer to your particular provider type program chapter for clarification. 1044 0 obj <> endobj Claims will be processed according to timely filing provisions in the providers Absolute Total Care Participating Provider Agreement. Explains how to receive, load and send 834 EDI files for member information. We expect this process to be seamless for our valued members, and there will be no break in their coverage.

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