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. How will credentialing/recredentialing be handled by Absolute Total Care if a provider was recently credentialed/recredentialed by WellCare? If Statement Range is April 2, 2021 through April 10, 2021, please send to Absolute Total Care. If you file a grievance or an appeal, we must be fair. 1044 0 obj <> endobj How do I determine if an institutional inpatient bill type submission overlapping 4/1/2021 should be filed to WellCare or Absolute Total Care? UnitedHealthcare Dual Complete Special Needs Plan UnitedHealthcare Dual Complete Special Needs Plans (SNP) offer benefits for people with both Medicare and Medicaid. As of April 1, 2021, all WellCare of South Carolina Medicaid members will become Absolute Total Care members. A. 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. Copyright 2023 Wellcare Health Plans, Inc. We are glad you joined our family! 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. Click below for more information from Absolute Total Care: You are now able to view your health information from a third-party app on a mobile device or PC! Need an account? However, there will be no members accessing/assigned to the Medicaid portion of the agreement. It will let you know we received your appeal. The annual flu vaccine helps prevent the flu.Protect yourself and those around you. The benefit can be used to get more than 150 items - including vitamins, pain relievers, cold and allergy medicines, baby wipes, and diapers - at no cost . 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. For as long as your member has an active WellCare subscriber number, you should continue to submit claims directly to WellCare as you have in the past. Attn: Grievance Department 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. Q. Addakam ditoy para kenka. Instructions on how to submit a corrected or voided claim. You can file the grievance yourself. We are simplifying Medicare so you can choose and use an affordable local plan that will help you achieve your best possible health. Know the facts about Coronavirus (COVID-19) Our call centers, including the nurse advice line, are currently experiencing high volume. A. The annual flu vaccine helps prevent the flu. Instructions on how to submit a corrected or voided claim. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. We try to make filing claims with us as easy as possible. 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). 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. Additionally, WellCare will have a migration section on their provider page at publishing FAQs. 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 can get many of your Coronavirus-related questions answered here. Here are some guides we created to help you with claims filing. We expect this process to be seamless for our valued members and there will be no break in their coverage. Members can continue to receive services from their current WellCare provider as long as they remain covered under WellCare. Contact Wellcare Prime Provider Service at1-855-735-4398if youhave questions. You can file your appeal by calling or writing to us. Wellcare uses cookies. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. Q. Will WellCare continue to offer current products or Medicare only? To do so by phone, call Member Services at 1-888-588-9842 (TTY1-877-247-6272). 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. A. Where should I submit claims for WellCare Medicaid members that transition to Absolute Total Care? The onlineProvider Manual represents the most up-to-date information on Absolute Total Cares Medicaid Plan, programs, policies, and procedures. Shop or Enroll in a Plan Frequently Asked Questions Find a Doctor Download Digital ID Card Welcome Allwell 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. Explains how to receive, load and send 834 EDI files for member information. Always verify timely filing requirements with the third party payor. Get an annual flu shot today. As of April 1, 2021, all WellCare of South Carolina Medicaid members will transfer to Absolute Total Care. 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. If you are unable to view PDFs, please download Adobe Reader. 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. 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. If you need claim filing assistance, please contact your provider advocate. Want to receive your payments faster to improve cash flow? Earliest From Dates prior to 4/1/2021 should be filed to WellCare of South Carolina. Examples: If Statement Range is March 14, 2021 through April 3, 2021, please send to WellCare. 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. 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. 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. Explains rules and state, line of business and CMS-specific regulations regarding 837P EDI transactions. Claims Department Farmington, MO 63640-3821. Kasapulam ti tulong? Claims will be processed according to timely filing provisions in the providers WellCare Participating Provider Agreement. Select Health Claims must be filed within 12 months from the date of service. Claims for services on or after April 1, 2021 should be filed to Absolute Total Care for processing. WellCare claims will be processed according to timely filing provisions in the providers WellCare Participating Provider Agreement. More Information Coronavirus (COVID-19) Our health insurance programs are committed to transforming the health of the community one individual at a time. 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. You or your authorized representative will tell the hearing officer why you think we made the wrong decision. Please use the From Date Institutional Statement Date. Absolute Total Care Providers can help facilitate timely claim payment by having an understanding of our processes and requirements. Electronic and Paper Claims Submissions; Institutional Claims/Encounter Guides. For as long as your member has an active WellCare subscriber number, you should continue to submit claims directly to WellCare as you have in the past. You will get a letter from us when any of these actions occur. You, your friend, a relative, legal counsel or other spokesperson who has your written consent may ask for a State Fair Hearing. However, there will be no members accessing/assigned to the Medicaid portion of the agreement. 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. Box 100605 Columbia, SC 29260. You will need Adobe Reader to open PDFs on this site. Awagandakami We will also send you a letter with our decision within 72 hours from receiving your appeal. Provider can't require members to appoint them as a condition of getting services. Q. With the completion of this transaction, we have created a premier healthcare enterprise focused on government-sponsored healthcare programs. Timely filing limits vary. Payments mailed to providers are subject to USPS mailing timeframes. All dates of service on or after April 1, 2021 should be filed to Absolute Total Care. Q. Written notice is not needed if your expedited appeal request is filed verbally. Will Absolute Total Care change its name to WellCare? Obstetrician care provided by an out-of-network obstetrician will be covered for pregnant members inclusive of postpartum care. Wellcare uses cookies. It was a smart move. 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. 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. To avoid rejections please split the services into two separate claim submissions. To do so by phone, call Member Services at 1-888-588-9842 (TTY1-877-247-6272). DOS April 1, 2021 and after: Processed by Absolute Total Care. You can file a grievance by calling or writing to us. A. Explains rules and state, line of business and CMS-specific regulations regarding 837I EDI transactions. How do I determine if a professional or an outpatient bill type institutional submission should be filed to WellCare or Absolute Total Care? you have another option. All dates of service on or after 4/1/2021 should be filed to Absolute Total Care. Forms. We will continue covering your medical services during your appeal request and State Fair Hearing if all of the following are meet. 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. 941w*)bF iLK\c;nF mhk} Register now at https://www.payspanhealth.com or contact PaySpan at providersupport@payspanhealth.com, or 877-331-7154. P.O. Box 8206 Columbia, SC 29202-8206 Or call 1-800-763-9087. This manual sets forth the policies and procedures that providers participating in the Absolute Total Carenetwork are required tofollow. Absolute Total Care will honor all existing WellCare authorization approvals that include dates of service beyond March 31, 2021. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. If you dont, we will have to deny your request. To do this: Be sure to ask us to continue your benefits within the 10 calendar day time frame. Q. P.O. A. All billing requirements must be adher ed to by the provider in order to ensure timely processing of claims. Q: What is Absolute Total Cares Transition/Continuity of Care Policy? Explains rules and state, line of business and CMS-specific regulations regarding 837P EDI transactions. This must be done within 120 days from the date of Notice of Appeal Resolution you received from us. $8v + Yu @bAD`K@8m.`:DPeV @l However, there will be no members accessing/assigned to the Medicaid portion of the agreement. Call us to get this form. Refer to your particular provider type program chapter for clarification. Providers can begin requesting prior authorization from Absolute Total Care for dates of service on or after 4/1/2021 from Absolute Total Care on, Providers can begin requesting prior authorization for pharmacy services from Absolute Total Care for dates of service on or after 4/1/2021 from Absolute Total Care on. If you wish to use a representative, then he or she must complete an Appointment of Representative (AOR) statement. WellCare of North Carolina partners with providers to develop and deliver high-quality, cost-effective health care solutions. A. Farmington, MO 63640-3821. Claims will be processed according to timely filing provisions in the providers Absolute Total Care Participating Provider Agreement. #~0 I You may file your second level grievance review within 30 days of receiving your grievance decision letter. To continue care with their current provider after the 90-day Transition of Care, the provider must agree to work with Absolute Total Care on the member's care and accept Absolute Total Care's payment rates. Earliest From Dates on or after April 1, 2021 should be filed to Absolute Total Care. How are WellCare Medicaid member authorizations being handled after April 1, 2021? Because those authorizations will automatically transfer to Absolute Total Care, it is not necessary to request the authorization again when the member becomes eligible with Absolute Total Care. Claims for services prior to April 1, 2021 should be filed to WellCare for processing. N .7$* P!70 *I;Rox3 ] LS~. WellCare understands that having access to the right tools can help you and your staff streamline day-to-day administrative tasks. For standard requests, if you call in your appeal, you must follow up with a written, signed one, within thirty calendar days. An appeal is a request you can make when you do not agree with a decision we made about your care. WellCare has partnered with Change Healthcare as our preferred EDI Clearinghouse. Or it can be made if we take too long to make a care decision. pst/!+ Y^Ynwb7tw,eI^ The Medicare portion of the agreement will continue to function in its entirety as applicable. 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. 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 As of April 1, 2021, all WellCare of South Carolina Medicaid members will become Absolute Total Care members. 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. How do I join Absolute Total Cares provider network? From Date Institutional Statement Dates prior to 4/1/2021 should be filed to WellCare of South Carolina. WellCare of South Carolina will be known as Absolute Total Care as of April 1, 2021. First Choice can accept claim submissions via paper or electronically (EDI). A. Will Absolute Total Care continue to offer Medicare and Marketplace products? Division of Appeals and Hearings Please Explore the Site and Get To Know Us. It is called a "Notice of Adverse Benefit Determination" or "NABD." Professional and Institutional Encounter EDI transactions should be submitted to WellCare of South Carolina Medicaid with Payer ID 59354. This gives members time to establish with a new provider in the network and ensure that they have continuity of care. 3) Coordination of Benefits. 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. With the completion of this transaction, we have created a premier healthcare enterprise focused on government-sponsored healthcare programs. Box 8206 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. WellCare offers participating providers EFT and ERA services at no charge through PaySpan Health. We may apply a 14 day extension to your grievance resolution. Q. People of all ages can be infected. Those who attend the hearing include: You can also request to have your hearing over the phone. Yes, Absolute Total Care and WellCare will continue to offer Medicare products under their current brands and product names, until further notice. Select your topic and plan and click "Chat Now!" to chat with a live agent! That's why we provide tools and resources to help. Providers can help facilitate timely claim payment by having an understanding of our processes and requirements. 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. Pregnant members receiving care from an out-of-network Obstetrician can continue to see their current obstetrician until after the baby is born. Thanka kaa yoa Tufrbeau ingsnh ngetfu South Caralaita nouMa mpvd. Where should I submit claims for WellCare Medicaid 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. As of April 1, 2021, all WellCare of South Carolina Medicaid members will transfer to Absolute Total Care. P.O. 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. These materials are for informational purposes only. Providers are encouraged to visit the Provider Resources webpagefor manuals, forms, and resources related to claims submission, eligibility, prior authorization, and more. %%EOF Reimbursement Policies The Medicare portion of the agreement will continue to function in its entirety as applicable. 837 Institutional Encounter 5010v Guide We will notify you orally and in writing. Section 1: General Information. 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. Box 3050 B^E{h#XYQv;[ny3Hha1yx4v.sBy jWacQzyL.kHhwtQ~35!Rh#)p+sj31LcC)4*Z:IWIG@WTD- )n,! Q. WellCare Medicare members are not affected by this change. For dates of service on or after April 1, 2021: Absolute Total Care We cannot disenroll you from our plan or treat you differently. hbbd``b`$= $ 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. 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. endstream endobj startxref Members will receive a 90-day transition of care period if the member is receiving ongoing care and treatment. Tampa, FL 33631-3384. 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 . WellCare of North Carolina will begin to release medical payments to providers beginning July 6, 2021. Only you or your authorizedrepresentative can ask for a State Fair Hearing. Professional and Institutional Fee-For-Service EDI transactions should be submitted to WellCare of South Carolina Medicaid with Payer ID 14163. 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. A. 2023 Medicare and PDP Compare Plans and Enroll Now. Explains rules and state, line of business and CMS-specific regulations regarding 837I EDI transactions. Box 600601 Columbia, SC 29260. Wellcare uses cookies. We're here for you. A. Please use WellCare Payor ID 14163. Please use the Earliest From Date. 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