If you need claim filing assistance, please contact your provider advocate. Keep yourself informed about Coronavirus (COVID-19.) Explains how to receive, load and send 834 EDI files for member information. We try to make filing claims with us as easy as possible. Members who are dealing with stress or anxiety can call our 24-Hour Behavioral Health Crisis Line at 1-833-207-4240 to speak with a trained professional. Reconsideration or Claim Disputes/Appeals: We are committed to improving the quality of life of our millions of members, who often include some of our nations most vulnerable populations. We are proud to announce that WellCare is now part of the Centene Family. The hearing officer does not decide in your favor. Q. You can make three types of grievances. You can get many of your Coronavirus-related questions answered here. Tampa, FL 33631-3372. It was a smart move. 8h} \x p`03 1z`@+`~70 G ~Ws5Puick79,4 ,O5@?O-Gr'|5Oj:v6/` Please use the Earliest From Date. First Choice can accept claim submissions via paper or electronically (EDI). Providers interested in joining the Absolute Total Care vision network for routine vision services can contact Envolve Vision at 1-800-531-2818. There is a lot of insurance that follows different time frames for claim submission. Where should I submit claims for WellCare Medicaid members? Example of how to properly split claim that span the cutover date of April 1, 2021: Q. Members can continue to receive services from their current WellCare provider as long as they remain covered under WellCare. We are glad you joined our family! You can get many of your Coronavirus-related questions answered here. 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. For dates of service on or after 4/1/2021: 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. A grievance is when you tell us about a concern you have with our plan. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. How do I bill a professional submission with services spanning before and after 04/01/2021? Q. Date of Occurrence/DOSApril 1, 2021 and after: Processed by Absolute Total Care. We expect this process to be seamless for our valued members and there will be no break in their coverage. Guides Filing Claims with WellCare. N .7$* P!70 *I;Rox3 ] LS~. Q. As of April 1, 2021, all WellCare of South Carolina Medicaid members will transfer to Absolute Total Care. 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. Effective January 1, 2015 the South Carolina Department of Health and Human Services (SCDHHS) will implement a Claim Reconsideration Policy. Wellcare uses cookies. We would like to help your billing department get your EDI (claims and real time) transactions processed as efficiently as possible. The annual flu vaccine helps prevent the flu. 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. Examples: If Statement Range is March 14, 2021 through April 3, 2021, please send to WellCare. Members must have Medicaid to enroll. If at any time you need help filing one, call us. endstream endobj startxref Q. P.O. 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. Wellcare uses cookies. People of all ages can be infected. The Claim Reconsideration process is an informal claim review, and is not a substitute for an appeal of a final agency decision. How are WellCare Medicaid member authorizations being handled after April 1, 2021? Utilize interactive health and wellness tools to help you manage conditions, improve your health and save money. WellCare and Absolute Total Care Medicare plans will continue to operate under current brands, product names and provider contracts, until further notice. You now have access to a secure, quick way to electronically settle claims. Box 600601 Columbia, SC 29260. Q. 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. Shop or Enroll in a Plan Frequently Asked Questions Find a Doctor Download Digital ID Card Welcome Allwell Members! You may do this in writing or in person. North Carolina PHP Billing Guidance for Local W Code. Tampa, FL 33631-3372. The Medicare portion of the agreement will continue to function in its entirety as applicable. WellCare understands that having access to the right tools can help you and your staff streamline day-to-day administrative tasks. Will my existing WellCare patients be assigned to my Absolute Total Care Panel? %PDF-1.6 % 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 . Tampa, FL 33631-3384. The hearing officer will decide whether our decision was right or wrong. WellCare of South Carolina will be known as Absolute Total Care as of April 1, 2021. 1,flQ*!WLOmsmz\D;I5BI,yA#z!vYQi5'fedREF40 b666q1(UtUJJ.i` (T/@E Timely Filing Limits for all Insurances updated (2023) - Bcbsproviderphonenumber Timely Filing Limits for all Insurances updated (2023) One of the common and popular denials is passed the timely filing limit. DOS April 1, 2021 and after: Processed by Absolute Total Care. 1071 0 obj <>/Filter/FlateDecode/ID[<87133B316ADA4BDD8B85BA48A489D34F>]/Index[1044 53]/Info 1043 0 R/Length 117/Prev 692690/Root 1045 0 R/Size 1097/Type/XRef/W[1 2 1]>>stream 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. This person has all beneficiary rights and responsibilities during the appeal process. pst/!+ Y^Ynwb7tw,eI^ For current information, visit the Absolute Total Care website. Thanka kaa yoa Tufrbeau ingsnh ngetfu South Caralaita nouMa mpvd. Absolute Total Care will continue to offer Marketplace products under the Ambetter brand. Farmington, MO 63640-3821. Will Absolute Total Care continue to offer Medicare and Marketplace products? You can file your appeal by calling or writing to us. Need an account? Explains rules and state, line of business and CMS-specific regulations regarding 837P EDI transactions. The annual flu vaccine helps prevent the flu.Protect yourself and those around you. Claims will be processed according to timely filing provisions in the providers WellCare Participating Provider Agreement. You or your authorized representative will tell the hearing officer why you think we made the wrong decision. An appeal may be filed within 60 calendar days from the date on the Adverse Benefit Determination Notice. Copyright 2023 Wellcare Health Plans, Inc. For standard requests, if you call in your appeal, you must follow up with a written, signed one, within thirty calendar days. This manual sets forth the policies and procedures that providers participating in the Absolute Total Carenetwork are required tofollow. Synagis (RSV) - Medical Benefit or Retail Pharmacy, 17P or Makena - Medical Benefit or Retail Pharmacy, Special Supplemental Benefits for Chronically Ill (SSBCI), Screening, Brief Intervention, and Referral to Treatment (SBIRT), Patient Centered Medical Home Model (PCMH), Healthcare Effectiveness Data and Information Set (HEDIS), Consumer Assessment of Healthcare Providers and Systems (CAHPS), National Committee for Quality Assurance (NCQA), Hurricane Florence: What You Need to Know, Absolute Total Care Payment Policy and Edit Updates Effective 5/1/21, Notice About a New Payment Integrity Audit Program, Absolute Total Care Updated Guidance for Medicaid BabyNet Therapy Providers, Wellcare By Allwell Changing Peer-to-Peer Review Request and Elective Inpatient Prior Authorization Requirements for Medicare Advantage Plans, NEW Attestation Process for Special Supplemental Benefits for Chronically Ill (SSBCI), Medicare Prior Authorization Change Summary - Effective 1/1/2023. WellCare of South Carolinawants to ensure that claims are handled as efficiently as possible. For additional information, questions or concerns, please contact your local Provider Network Management Representative. Medicaid Claims Payment Policies 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 Earliest From Dates prior to April 1, 2021 should be filed to WellCare of South Carolina. We process check runs daily, with the exception of Sundays, National Holidays, and the last day of the month. 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. As of April 1, 2021 Absolute Total Care, a Centene company, is now the health plan for South Carolina Medicaid members. A hearing officer from the State will decide if we made the right decision. For the latest COVID-19 news, visit the CDC. * Password. Contact Wellcare Prime Provider Service at 1-855-735-4398 if you have questions. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. Only you or your authorizedrepresentative can ask for a State Fair Hearing. 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. 0 Claims will be processed according to timely filing provisions in the providers WellCare Participating Provider Agreement. Members who are dealing with stress or anxiety can call our 24-Hour Behavioral Health Crisis Line at 1-833-207-4240 to speak with a trained professional. Q. Reimbursement Policies Instructions on how to submit a corrected or voided claim. South Carolina DEPARTMENT OF HEALTH AND HUMAN SERVICES Post Office Box 8206 Columbia, South Carolina 29202-8206 www.scdhhs.gov November 24, 2009 ALL . Or you can have someone file it for you. WellCare is the health care plan that puts you in control. Timely filing is when you file a claim within a payer-determined time limit. We will give you information to help you get the most from your benefits and the services we provide. As of April 1, 2021, all WellCare of South Carolina Medicaid members will transfer to Absolute Total Care. 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. Additionally, WellCare will have a migration section on their provider page at publishing FAQs. Copyright 2023 Wellcare Health Plans, Inc. All Paper Claim Submissions can be mailed to: WellCare Health Plans As of April 1, 2021, WellCare will no longer be a separate plan option offered by South Carolina Healthy Connections Choices. Claim Filing AmeriHealth Caritas North Carolina, hereafter referred to as the Plan (where appropriate), is required by the North Carolina and federal regulations to capture specific data regarding services rendered to its members. Ancillary Claims Filing Reminders; ClaimsXten TM: Correct Coding Initiative Reference Guide; Inpatient Non-Reimbursable Charges/Unbundling Policy hb```b``6``e`~ "@1V NB, With the completion of this transaction, we have created a premier healthcare enterprise focused on government-sponsored healthcare programs. 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 will continue to work directly with WellCare to address any claims for dates of service prior to the membership transfer of April 1, 2021. You may request a State Fair Hearing at this address: South Carolina Department of Health $8v + Yu @bAD`K@8m.`:DPeV @l 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. Earliest From Dates on or after 4/1/2021 should be filed to Absolute Total Care. 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. You can also have a video visit with a doctor using your phone or computer. Beginning. The onlineProvider Manual represents the most up-to-date information on Wellcare Prime by Absolute Total Care (Medicare-Medicaid Plan), programs, policies, and procedures. At the hearing, well explain why we made our decision. 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. Awagandakami Q. 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. All dates of service on or after April 1, 2021 should be filed to Absolute Total Care. You will receive an acknowledgement letter within 5 business days, and we will send you a resolution within 90 calendar days. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. If Statement Range is April 2, 2021 through April 10, 2021, please send 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. A. 2) Reconsideration or Claim disputes/Appeals. You must file your appeal within 60 calendar days from the date on the NABD. Outpatient Prior Authorization Form (PDF) Inpatient Prior Authorization Form (PDF) A. You may file your second level grievance review within 30 days of receiving your grievance decision letter. Wellcare uses cookies. Explains rules and state, line of business and CMS-specific regulations regarding 837I EDI transactions. For general questions about claims submissions, call Provider Claims Services at 1-800-575-0418. P.O. Q. Wfu neebybfgnh bgWfulnybfgC South Carolina Medicaid Provider Resource Guide Thank you for being a star member of our provider team. A. 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. No, Absolute Total Care will continue to operate under the Absolute Total Care name. To avoid rejections please split the services into two separate claim submissions. DOS prior to April 1, 2021: Processed by WellCare. Professional and Institutional Fee-For-Service EDI transactions should be submitted to WellCare of South Carolina Medicaid with Payer ID 14163. Additionally, WellCare will have a migration section on their provider page at publishing FAQs. Or it can be made if we take too long to make a care decision. This gives members time to establish with a new provider in the network and ensure that they have continuity of care. These materials are for informational purposes only. All transitioning Medicaid members will receive a welcome packet and new member 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. You will need Adobe Reader to open PDFs on this site. P.O. Please use the earliest From Date. It is called a "Notice of Adverse Benefit Determination" or "NABD." With the completion of this transaction, we have created a premier healthcare enterprise focused on government-sponsored healthcare programs. Q. 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. P.O. The way your providers or others act or treat you. Farmington, MO 63640-3821. All dates of service prior to 4/1/2021 should be filed to WellCare of South Carolina. The timely filing limit is the time duration from service rendered to patients and submitting claims to the insurance companies. Instructions on how to submit a corrected or voided claim. A. Explains how to receive, load and send 834 EDI files for member information. 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. The onlineProvider Manual represents the most up-to-date information on Absolute Total Cares Medicaid Plan, programs, policies, and procedures. Claims for services prior to April 1, 2021 should be filed to WellCare for processing. Symptoms are flu-like, including: Fever Coughing Federal Employee Program (FEP) Federal Employee Program P.O. These SNP plans provide benefits beyond Original Medicare, and may include transportation to medical appointments and vision exams. 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. A. Exceptions to the one-year time limit: a) Medicare Cost Sharing Claims . Columbia, SC 29202-8206. 3) Coordination of Benefits. April 1-April 3, 2021, please send to Absolute Total Care. Contact Absolute Total Care Provider Service at1-866-433-6041if youhave questions. You must ask within 30 calendar days of getting our decision. #~0 I Get an annual flu shot today. They are called: State law allows you to make a grievance if you have any problems with us. Members will need to talk to their provider right away if they want to keep seeing him/her. Absolute Total Care will continue to offer Marketplace products under the Ambetter brand. 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. 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.