Earliest From Dates prior to April 1, 2021 should be filed to WellCare of South Carolina. You or your provider must call or fax us to ask for a fast appeal. 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. A. They are called: State law allows you to make a grievance if you have any problems with us. WellCare of South Carolina will be known as Absolute Total Care as of April 1, 2021. Learn how you can help keep yourself and others healthy. Farmington, MO 63640-3821. Payments mailed to providers are subject to USPS mailing timeframes. * Username. WellCare of South Carolinawants to ensure that claims are handled as efficiently as possible. 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. Absolute Total Care will honor those authorizations. Professional and Institutional Encounter EDI transactions should be submitted to WellCare of South Carolina Medicaid with Payer ID 59354. 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 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. Our health insurance programs are committed to transforming the health of the community one individual at a time. At the hearing, well explain why we made our decision. Contact Wellcare Prime Provider Service at1-855-735-4398if youhave questions. 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. All Paper Claim Submissions can be mailed to: WellCare Health Plans 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. 0 Contact Absolute Total Care Provider Service at1-866-433-6041if youhave questions. We will continue covering your medical services during your appeal request and State Fair Hearing if all of the following are meet. How do I determine if a professional or an outpatient bill type institutional submission should be filed to WellCare or Absolute Total Care? South Carolina | Wellcare SOUTH CAROLINA Healthcare done well. 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. Q: What is Absolute Total Cares Transition/Continuity of Care Policy? Welcome to WellCare of South Carolina! 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. Guides Filing Claims with WellCare. Q. Keep yourself informed about Coronavirus (COVID-19.) Forgot Your Password? As of April 1, 2021, WellCare will no longer be a separate plan option offered by South Carolina Healthy Connections Choices. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. Timely filing limits vary. The materials located on our website are for dates of service prior to April 1, 2021. With the completion of this transaction, we have created a premier healthcare enterprise focused on government-sponsored healthcare programs. 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. We're here for you. These SNP plans provide benefits beyond Original Medicare, and may include transportation to medical appointments and vision exams. Q. Where should I submit claims for WellCare Medicaid members? Claims will be processed according to timely filing provisions in the providers WellCare Participating Provider Agreement. Date of Occurrence/DOSprior toApril 1, 2021: Processed by WellCare. WellCare Medicare Advantage Claims must be filed within 180 calendar days from the date of service. South Carolina Department of Health and Human Services Division of Appeals and Hearings P.O. 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. $8v + Yu @bAD`K@8m.`:DPeV @l This gives members time to establish with a new provider in the network and ensure that they have continuity of care. WellCare and Absolute Total Care Medicare plans will continue to operate under current brands, product names and provider contracts, until further notice. DOSApril 1, 2021 and after: Processed by Absolute Total Care. Members will need to talk to their provider right away if they want to keep seeing him/her. Register now. You must file your appeal within 60 calendar days from the date on the NABD. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. 941w*)bF iLK\c;nF mhk} With the completion of this transaction, we have created a premier healthcare enterprise focused on government-sponsored healthcare programs. Symptoms are flu-like, including: Fever Coughing We would like to help your billing department get your EDI (claims and real time) transactions processed as efficiently as possible. We will give you information to help you get the most from your benefits and the services we provide. With quality healthcare solutions, Ambetter from Absolute Total Care helps residents of South Carolina live better. We process check runs daily, with the exception of Sundays, National Holidays, and the last day of the month. A. Transition/Continuity of Care is an extended period of time members are given when they join or transfer to another plan in order to receive services from out-of-network providers and/or pharmacies, until that specified period ends. To avoid rejections please split the services into two separate claim submissions. Professional and Institutional Fee-For-Service EDI transactions should be submitted to WellCare of South Carolina Medicaid with Payer ID 14163. Forms. All dates of service on or after April 1, 2021 should be filed to Absolute Total Care. Instructions on how to submit a corrected or voided claim. A. Absolute Total Care WellCare is the health care plan that puts you in control. 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. Send your written appeal to: We must have your written consent before someone can file an appeal for you. We want to ensure that claims are handled as efficiently as possible. To avoid rejections please split the services into two separate claim submissions. A. B^E{h#XYQv;[ny3Hha1yx4v.sBy jWacQzyL.kHhwtQ~35!Rh#)p+sj31LcC)4*Z:IWIG@WTD- )n,! 837 Institutional Encounter 5010v Guide By continuing to use our site, you agree to our Privacy Policy and Terms of Use. Overview & Resources WellCare of North Carolina partners with providers to develop and deliver high-quality, cost-effective health care solutions. Refer to your particular provider type program chapter for clarification. You can get many of your Coronavirus-related questions answered here. 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. Instructions on how to submit a corrected or voided claim. A. 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. This manual sets forth the policies and procedures that providers participating in the Wellcare Prime network are required to follow. Please be sure to use the correct line of business prior authorization form for prior authorization requests. 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. These materials are for informational purposes only. The rules include what we must do when we get a grievance. Within five business days of getting your grievance, we will mail you a letter. the timely filing limits due to the provider being unaware of a beneficiary's coverage. 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. 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 . An appeal may be filed within 60 calendar days from the date on the Adverse Benefit Determination Notice. Earliest From Dates on or after April 1, 2021 should be filed to Absolute Total Care. 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. z4M0(th`1Lf`M18c BIcJ[%4l JU2 _ s Members will need to talk to their provider right away if they want to keep seeing him/her. 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. More Information Need help? We cannot disenroll you from our plan or treat you differently. 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 . Q. 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 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 DOS prior to April 1, 2021: Processed by WellCare. Ambetter from Absolute Total Care - South Carolina. 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. We may apply a 14 day extension to your grievance resolution. Exceptions to the one-year time limit: a) Medicare Cost Sharing Claims . Electronic and Paper Claims Submissions; Institutional Claims/Encounter Guides. 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 can ask in writing for a State Fair Hearing (hearing, for short). If you wish to use a representative, then he or she must complete an Appointment of Representative (AOR) statement. 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? Claims will be processed according to timely filing provisions in the providers WellCare Participating Provider Agreement. Q. 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. To write us, send mail to: You can fax it too. To do so by phone, call Member Services at 1-888-588-9842 (TTY1-877-247-6272). Box 8206 Columbia, SC 29202-8206 Or call 1-800-763-9087. S< We will call you with our decision if we decide you need a fast appeal. 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. We are proud to announce that WellCare is now part of the Centene Family. Effective January 1, 2015 the South Carolina Department of Health and Human Services (SCDHHS) will implement a Claim Reconsideration Policy. Wellcare uses cookies. You can make three types of grievances. Explains rules and state, line of business and CMS-specific regulations regarding 837P EDI transactions. For the death or injury of a member of the South Carolina National Guard, as provided for in Section 42-7-67, the time for filing a claim is two years after the accident or one year after the federal claim is finalized, whichever is later. Transition/continuity of care is an extended period of time members are given when they join or transfer to another plan in order to receive services from out-of-network providers and/or pharmacies, until that specified period ends. You may do this in writing or in person. A provider can act for a member in hearings with the member's written permission in advance. For requests involving dates of service on April 1, 2021 and beyond, Absolute Total Care will follow Medicaid contract requirements allowing a 90-day transition of care period. Wellcare uses cookies. WellCare and Absolute Total Care Medicare plans will continue to operate under current brands, product names and provider contracts, until further notice. 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. A. Absolute Total Care will honor those authorizations. Federal Employee Program (FEP) Federal Employee Program P.O. The second level review will follow the same process and procedure outlined for the initial review. What will happen to unresolved claims prior to the membership transfer? 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. You can file the grievance yourself. 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. Absolute Total Care will honor all existing WellCare authorization approvals that include dates of service beyond March 31, 2021. However, there will be no members accessing/assigned to the Medicaid portion of the agreement. endstream endobj 1045 0 obj <>/Metadata 50 0 R/OpenAction 1046 0 R/Outlines 160 0 R/Pages 1042 0 R/StructTreeRoot 166 0 R/Type/Catalog/ViewerPreferences<>>> endobj 1046 0 obj <> endobj 1047 0 obj <>/Font<>/ProcSet[/PDF/Text/ImageC/ImageB/ImageI]/XObject<>>>/Rotate 0/StructParents 0/Tabs/S/TrimBox[0.0 0.0 612.0 792.0]/Type/Page>> endobj 1048 0 obj <>stream If at any time you need help filing one, call us. 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. The provider needs to contact Absolute Total Care to arrange continuing 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. Wellcare uses cookies. Written notice is not needed if your expedited appeal request is filed verbally. Only you or your authorizedrepresentative can ask for a State Fair Hearing. The Claim Reconsideration process is an informal claim review, and is not a substitute for an appeal of a final agency decision. 3) Coordination of Benefits.
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