endstream endobj startxref Q. Timely Filing Beginning October 1, 2020, the Timely Filing submission requirements specified in each Provider's Meridian Medicare contract will be enforced. From Date Institutional Statement Dates prior to 4/1/2021 should be filed to WellCare of South Carolina. 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. Earliest From Dates on or after April 1, 2021 should be filed to Absolute Total Care. You will have a limited time to submit additional information for a fast appeal. 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. Wellcare uses cookies. WellCare claims will be processed according to timely filing provisions in the providers WellCare Participating Provider Agreement. Tampa, FL 33631-3372. Send your written appeal to: We must have your written consent before someone can file an appeal for you. Only you or your authorizedrepresentative can ask for a State Fair Hearing. To avoid rejections please split the services into two separate claim submissions. If you request a hearing, the request must: A State Fair Hearing is a legal proceeding. Date of Occurrence/DOSprior toApril 1, 2021: Processed by WellCare. Box 100605 Columbia, SC 29260. Wellcare uses cookies. How are WellCare Medicaid member authorizations being handled after April 1, 2021? Register now at https://www.payspanhealth.comor contact PaySpan at providersupport@payspanhealth.com, or 877-331-7154. Overview & Resources WellCare of North Carolina partners with providers to develop and deliver high-quality, cost-effective health care solutions. Claim Filing Manual - First Choice by Select Health of South Carolina 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. There is a lot of insurance that follows different time frames for claim submission. 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 Section 1: General Information. People of all ages can be infected. Search for primary care providers, hospitals, pharmacies, and more! The rules include what we must do when we get a grievance. Kasapulam ti tulong? To avoid rejections please split the services into two separate claim submissions. WellCare of North Carolina will begin to release medical payments to providers beginning July 6, 2021. Example of how to properly split claim that span the cutover date of April 1, 2021: Q. To do so by phone, call Member Services at 1-888-588-9842 (TTY1-877-247-6272). 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 . Yes, Absolute Total Care and WellCare will continue to offer Medicare products under their current brands and product names, until further notice. Members must have Medicaid to enroll. 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. 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. Provider can't require members to appoint them as a condition of getting services. 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. 3) Coordination of Benefits. As of April 1, 2021 Absolute Total Care, a Centene company, is now the health plan for South Carolina Medicaid members. The second level review will follow the same process and procedure outlined for the initial review. 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? 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. Wfu neebybfgnh bgWfulnybfgC South Carolina Medicaid Provider Resource Guide Thank you for being a star member of our provider team. Tampa, FL 33631-3384. Electronic and Paper Claims Submissions; Institutional Claims/Encounter Guides. A. The Claim Reconsideration process is an informal claim review, and is not a substitute for an appeal of a final agency decision. Know the facts about Coronavirus (COVID-19) Our call centers, including the nurse advice line, are currently experiencing high volume. Claims for services on or after April 1, 2021 should be filed to Absolute Total Care for processing. However, as of April 1, 2021, all WellCare of South Carolina Medicaid members will become Absolute Total Care members. Members can continue to receive services from their current WellCare provider as long as they remain covered under WellCare. At the hearing, well explain why we made our decision. An authorized representative is someone you select to act on the behalf of a member to assist them through the appeals process. April 1-April 3, 2021, please send to Absolute Total Care. Federal Employee Program (FEP) Federal Employee Program P.O. WellCare of South Carolina will be known as Absolute Total Care as of April 1, 2021. Those who attend the hearing include: You can also request to have your hearing over the phone. Download the free version of Adobe Reader. Guides Filing Claims with WellCare. 837 Institutional Encounter 5010v Guide Additionally, WellCare will have a migration section on their provider webpage publishing FAQs. Earliest From Dates prior to 4/1/2021 should be filed to WellCare of South Carolina. and Human Services 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. From Date Institutional Statement Dates on or after April 1, 2021 should be filed 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. This manual sets forth the policies and procedures that providers participating in the Wellcare Prime network are required tofollow. With the completion of this transaction, we have created a premier healthcare enterprise focused on government-sponsored healthcare programs. Always verify timely filing requirements with the third party payor. Please be sure to use the correct line of business prior authorization form for prior authorization requests. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. 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. Tampa, FL 33631-3372. Providers interested in joining the Absolute Total Care vision network for routine vision services can contact Envolve Vision at 1-800-531-2818. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. All dates of service on or after 4/1/2021 should be filed to Absolute Total Care. They are called: State law allows you to make a grievance if you have any problems with us. The hearing officer does not decide in your favor. All Paper Claim Submissions can be mailed to: WellCare Health Plans \{-w{,xI202100$0*bZf ,X AayhP3pYla" e 3G& `eoT#@ *;d Want to receive your payments faster to improve cash flow? As of April 1, 2021, all WellCare of South Carolina Medicaid members will become Absolute Total Care members. A. Written notice is not needed if your expedited appeal request is filed verbally. To have someone represent you, you must complete an Appointment of Representative (AOR) form. South Carolina | Wellcare SOUTH CAROLINA Healthcare done well. 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. Will Absolute Total Care continue to offer Medicare and Marketplace products? WellCare and Absolute Total Care Medicare plans will continue to operate under current brands, product names and provider contracts, until further notice. To do this: Be sure to ask us to continue your benefits within the 10 calendar day time frame. How do I determine if a professional or an outpatient bill type institutional submission should be filed to WellCare or Absolute Total Care? You can file your appeal by calling or writing to us. Providers can help facilitate timely claim payment by having an understanding of our processes and requirements. #~0 I Providers do not need to do anything additional to provide services on or after April 1, 2021 if the provider is in network with both WellCare and Absolute Total Care. 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! By continuing to use our site, you agree to our Privacy Policy and Terms of Use. 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. As of April 1, 2021, WellCare will no longer be a separate plan option offered by South Carolina Healthy Connections Choices. You will need Adobe Reader to open PDFs on this site. Box 3050 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. You can make three types of grievances. It is 30 days to 1 year and more and depends on . This gives members time to establish with a new provider in the network and ensure that they have continuity of care. %%EOF P.O. Awagandakami WellCare credentialing cycles will be shared with Absolute Total Care in order to reduce duplicative credentialing in the future. If Statement Range is March 14, 2021 through April 3, 2021, please send to WellCare. 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. Wellcare uses cookies. P.O. However, there will be no members accessing/assigned to the Medicaid portion of the agreement. 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. Date of Occurrence/DOSApril 1, 2021 and after: Processed by Absolute Total Care. Box 6000 Greenville, SC 29606. Claims Submission, Correspondence and Contact Resources will stay the same for the Medicare line of business. This gives members time to establish with a new provider in the network and ensure that they have continuity of care. 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). Claims for services prior to April 1, 2021 should be filed to WellCare for processing. As of April 1, 2021, all WellCare of South Carolina Medicaid members will transfer to Absolute Total Care. However, there will be no members accessing/assigned to the Medicaid portion of the agreement. For dates of service on or after April 1, 2021: Absolute Total Care WellCare offers participating providers EFT and ERA services at no charge through PaySpan Health. From Date Institutional Statement Dates on or after 4/1/2021 should be filed to Absolute Total Care. When can providers begin requesting prior authorization from Absolute Total Care for WellCare Medicaid members for dates of service on or after April 1, 2021? We may apply a 14 day extension to your grievance resolution. 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 * Username. Wellcare uses cookies. You can get many of your Coronavirus-related questions answered here. 2) Reconsideration or Claim disputes/Appeals. 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.

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