2023 Medicare and PDP Compare Plans and Enroll Now Notice of Non-Discrimination We comply with applicable Federal civil rights laws and do not discriminate on the basis of race, color, national origin, age, sex, or disability. 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. 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? Where should I submit claims for WellCare Medicaid members? 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. You and the person you choose to represent you must sign the AOR statement. 2) Reconsideration or Claim disputes/Appeals. WellCare Medicare Advantage Claims must be filed within 180 calendar days from the date of service. We will give you information to help you get the most from your benefits and the services we provide. You can file the grievance yourself. Please use the From Date Institutional Statement Date. Where should I submit claims for WellCare Medicaid members that transition to Absolute Total Care? Please be sure to use the correct line of business prior authorization form for prior authorization requests. You will receive an acknowledgement letter within 5 business days, and we will send you a resolution within 90 calendar days. Absolute Total Care will continue to offer Marketplace products under the Ambetter brand. Will Absolute Total Care change its name to WellCare? For dates of service prior to April 1, 2021: All paper claim submissions can be mailed to: WellCare Health Plans Q. WellCare claims will be processed according to timely filing provisions in the providers WellCare Participating Provider Agreement. 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. The annual flu vaccine helps prevent the flu. It was a smart move. To write us, send mail to: You can fax it too. P.O. 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. More Information Need help? DOSApril 1, 2021 and after: Processed by Absolute Total Care. Will my existing WellCare patients be assigned to my Absolute Total Care Panel? All Paper Claim Submissions can be mailed to: WellCare Health Plans WellCare has partnered with Change Healthcare as our preferred EDI Clearinghouse. With the completion of this transaction, we have created a premier healthcare enterprise focused on government-sponsored healthcare programs. 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 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. Forms. We try to make filing claims with us as easy as possible. 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. 1096 0 obj <>stream A. Your second-level review will be performed by person(s) not involved in the first review. We are committed to improving the quality of life of our millions of members, who often include some of our nations most vulnerable populations. What will happen to my Participating Provider Agreement with WellCare after 4/1/2021? The provider needs to contact Absolute Total Care to arrange continuing care. Learn how you can help keep yourself and others healthy. With the completion of this transaction, we have created a premier healthcare enterprise focused on government-sponsored healthcare programs. To do this: Be sure to ask us to continue your benefits within the 10 calendar day time frame. Providers interested in joining the Absolute Total Care vision network for routine vision services can contact Envolve Vision at 1-800-531-2818. Awagandakami $8v + Yu @bAD`K@8m.`:DPeV @l Claims for services prior to April 1, 2021 should be filed to WellCare for processing. A. Our toll-free fax number is 1-877-297-3112. You do not appeal within 10 calendar days from when the Plan mails an adverse Notice of Action, or you do not request a hearing within 10 calendar days from when the Plan mails an adverse Notice of Appeals Resolution whichever is later. Box 3050 Wfu neebybfgnh bgWfulnybfgC South Carolina Medicaid Provider Resource Guide Thank you for being a star member of our provider team. Box 100605 Columbia, SC 29260. 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. If an authorization is needed, you can log in to the Secure Provider Portal at absolutetotalcare.com to submit and confirm authorizations. Payments mailed to providers are subject to USPS mailing timeframes. First Choice can accept claim submissions via paper or electronically (EDI). By continuing to use our site, you agree to our Privacy Policy and Terms of Use. State Health Plan State Claims P.O. To do this: 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. Professional and Institutional Encounter EDI transactions should be submitted to WellCare of South Carolina Medicaid with Payer ID 59354. A. 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. WellCare of South Carolina will be known as Absolute Total Care as of April 1, 2021. If you are unable to view PDFs, please download Adobe Reader. B^E{h#XYQv;[ny3Hha1yx4v.sBy jWacQzyL.kHhwtQ~35!Rh#)p+sj31LcC)4*Z:IWIG@WTD- )n,! How do I determine if a professional or an outpatient bill type institutional submission should be filed to WellCare or Absolute Total Care? 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. 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. Q. Claims Submission, Correspondence and Contact Resources will stay the same for the Medicare line of business. March 14-March 31, 2021, please send to WellCare. April 1-April 3, 2021, please send to Absolute Total Care. We are glad you joined our family! A. 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. This person has all beneficiary rights and responsibilities during the appeal process. They must inform their vendor of AmeriHealth Caritas . This includes providing assistance with accessing interpreter services and hearing impaired . In South Carolina, WellCare and Absolute Total Care are joining to better serve you. The materials located on our website are for dates of service prior to April 1, 2021. 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. WellCare of South Carolina will be known as Absolute Total Care as of April 1, 2021. If an authorization is needed, you can log in to the Secure Provider Portalto submit and confirm authorizations. Claims will be processed according to timely filing provisions in the providers WellCare Participating Provider Agreement. We process check runs daily, with the exception of Sundays, National Holidays, and the last day of the month. For example, if any patient gets services on the 1st of any month then there is a time limit to submit his/her claim to the insurance company for reimbursement. Contact Wellcare Prime Provider Service at 1-855-735-4398 if you have questions. Ancillary Claims Filing Reminders; ClaimsXten TM: Correct Coding Initiative Reference Guide; Inpatient Non-Reimbursable Charges/Unbundling Policy Member Appeals (Medical, Behavioral Health, and Pharmacy): You will need Adobe Reader to open PDFs on this site. 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 expect this process to be seamless for our valued members and there will be no break in their coverage. How do I bill a professional submission with services spanning before and after 04/01/2021? Forgot Your Password? 8h} \x p`03 1z`@+`~70 G ~Ws5Puick79,4 ,O5@?O-Gr'|5Oj:v6/` pst/!+ Y^Ynwb7tw,eI^ Learn more about how were supporting members and providers. WellCare of South Carolinawants to ensure that claims are handled as efficiently as possible. An appeal is a request you can make when you do not agree with a decision we made about your care. (This includes your PCP or another provider.) An authorized representative is someone you select to act on the behalf of a member to assist them through the appeals process. Instructions on how to submit a corrected or voided claim. Written notice is not needed if your expedited appeal request is filed verbally. Resources Professional and Institutional Fee-For-Service EDI transactions should be submitted to WellCare of South Carolina Medicaid with Payer ID 14163. N .7$* P!70 *I;Rox3 ] LS~. You must ask within 30 calendar days of getting our decision. The rules include what we must do when we get a grievance. Please use the earliest From Date. The way your providers or others act or treat you. What will happen to unresolved claims prior to the membership transfer? Timely Filing Beginning October 1, 2020, the Timely Filing submission requirements specified in each Provider's Meridian Medicare contract will be enforced. Effective January 1, 2015 the South Carolina Department of Health and Human Services (SCDHHS) will implement a Claim Reconsideration Policy. 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. Wellcare uses cookies. Claims for services prior to April 1, 2021 should be filed to WellCare for processing. Tampa, FL 33631-3372. A. 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. Box 31224 Earliest From Dates prior to 4/1/2021 should be filed to WellCare of 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. If you wish to use a representative, then he or she must complete an Appointment of Representative (AOR) statement. Shop or Enroll in a Plan Frequently Asked Questions Find a Doctor Download Digital ID Card Welcome Allwell 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. We're here for you. Instructions on how to submit a corrected or voided claim. Tampa, FL 33631-3372. WellCare and Absolute Total Care Medicare plans will continue to operate under current brands, product names and provider contracts, until further notice. To avoid rejections please split the services into two separate claim submissions. 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. DOS prior to April 1, 2021: Processed by WellCare. 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. WellCare Health Plans, Inc. (NYSE: WCG) is now offering a $120 credit per family, per year towards over-the-counter (OTC) items as part of its Medicaid program benefits in South Carolina. Q. Q. Incorrect forms will not be considered and may lead to further delays in processing prior authorization requests. Our call centers, including the nurse advice line, are currently experiencing high volume. Will WellCare continue to offer current products or Medicare only? A. Welcome to Wellcare By Allwell, a Medicare Advantage plan. Date of Occurrence/DOSprior toApril 1, 2021: Processed by WellCare. Contact Absolute Total Care Provider Service at1-866-433-6041if youhave questions. Timely filing is when you file a claim within a payer-determined time limit. It will let you know we received your appeal. Select Health Claims must be filed within 12 months from the date of service. We would like to help your billing department get your EDI (claims and real time) transactions processed as efficiently as possible. WellCare of South Carolina will be known as Absolute Total Care as of April 1, 2021. 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. South Carolina Department of Health and Human Services Division of Appeals and Hearings P.O. You, your friend, a relative, legal counsel or other spokesperson who has your written consent may ask for a State Fair Hearing. 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. More Information Coronavirus (COVID-19) Select your topic and plan and click "Chat Now!" to chat with a live agent! 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. You will need Adobe Reader to open PDFs on this site. 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 are encouraged to visit the Provider Resources webpagefor manuals, forms, and resources related to claims submission, eligibility, prior authorization, and more. Explains rules and state, line of business and CMS-specific regulations regarding 837P EDI transactions. Providers can help facilitate timely claim payment by having an understanding of our processes and requirements. Reminder: It is important that providers check eligibility prior to providing services as members can potentially change plans prior to April 1, 2021 if they are in the annual choice period. How do I join Absolute Total Cares provider network? WellCare is the health care plan that puts you in control. Outpatient Prior Authorization Form (PDF) Inpatient Prior Authorization Form (PDF) Absolute Total Care will honor all existing WellCare authorization approvals that include dates of service beyond March 31, 2021. Register now. You may do this in writing or in person. %%EOF Here you will find the tools and resources you need to help manage your submission of claims and receipt of payments. Q. Wellcare uses cookies. Send your written appeal to: We must have your written consent before someone can file an appeal for you. We understand that maintaining a healthy community starts with providing care to those who need it most. Go365 for Humana Healthy Horizons Members can register for the new Go365 for Humana Healthy Horizons wellness program and earn rewards for participating in healthy activities. P.O. For the latest COVID-19 news, visit the CDC. Members can continue to receive services from their current WellCare provider as long as they remain covered under WellCare. Thanka kaa yoa Tufrbeau ingsnh ngetfu South Caralaita nouMa mpvd. 941w*)bF iLK\c;nF mhk} Or you can have someone file it for you. Wellcare wants to ensure that claims are handled as efficiently as possible. It is 30 days to 1 year and more and depends on . Q. For additional information, questions or concerns, please contact your local Provider Network Management Representative. 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. 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. 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. We must have your written permission before someone can file a grievance for you. Copyright 2023 Wellcare Health Plans, Inc. Ambetter Timely Filing Limit of : 1) Initial Claims. Explains rules and state, line of business and CMS-specific regulations regarding 837I EDI transactions. A. Professional and Institutional Fee-For-Service EDI transactions should be submitted to WellCare of South Carolina Medicaid with Payer ID 14163. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. Register now at https://www.payspanhealth.com or contact PaySpan at providersupport@payspanhealth.com, or 877-331-7154. %PDF-1.6 % We expect this process to be seamless for our valued members, and there will be no break in their coverage. Claims Department Timely filing limits vary. P.O. 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. WellCare and Absolute Total Care Medicare plans will continue to operate under current brands, product names and provider contracts, until further notice. Need an account? Claims will be processed according to timely filing provisions in the providers Absolute Total Care Participating Provider Agreement. Guides Filing Claims with WellCare. Claims will be processed according to timely filing provisions in the providers Absolute Total Care Participating Provider Agreement. We are simplifying Medicare so you can choose and use an affordable local plan that will help you achieve your best possible health. The Medicare portion of the agreement will continue to function in its entirety as applicable. Those who attend the hearing include: You can also request to have your hearing over the phone. All dates of service on or after April 1, 2021 should be filed to Absolute Total Care. Providers interested in joining the Absolute Total Care Provider Network should submit a request to Network Development and Contracting via email at. Please use the Earliest From Date. WellCare claims will be processed according to timely filing provisions in the providers WellCare Participating Provider Agreement. 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. You or your authorized representative can review the information we used to make our decision. Symptoms are flu-like, including: Fever Coughing Copyright 2023 Wellcare Health Plans, Inc. Please use the From Date Institutional Statement Date. The Claim Reconsideration process is an informal claim review, and is not a substitute for an appeal of a final agency decision. How will credentialing/recredentialing be handled by Absolute Total Care if a provider was recently credentialed/recredentialed by WellCare? WellCare Medicare members are not affected by this change. 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. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. If you think you might have been exposed, contact a doctor immediately. If Statement Range is April 2, 2021 through April 10, 2021, please send to Absolute Total Care. Q. 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. A provider can act for a member in hearings with the member's written permission in advance. Members will need to talk to their provider right away if they want to keep seeing him/her. z4M0(th`1Lf`M18c BIcJ[%4l JU2 _ s

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