The onlineProvider Manual represents the most up-to-date information on Wellcare Prime by Absolute Total Care (Medicare-Medicaid Plan), programs, policies, and procedures. You may request a State Fair Hearing at this address: South Carolina Department of Health Forms. 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. P.O. Kasapulam ti tulong? To avoid rejections please split the services into two separate claim submissions. WellCare claims will be processed according to timely filing provisions in the providers WellCare Participating Provider Agreement. You will need Adobe Reader to open PDFs on this site. What will happen to unresolved claims prior to the membership transfer? Farmington, MO 63640-3821. Date of Occurrence/DOSApril 1, 2021 and after: Processed by Absolute Total Care. 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. Ancillary Claims Filing Reminders; ClaimsXten TM: Correct Coding Initiative Reference Guide; Inpatient Non-Reimbursable Charges/Unbundling Policy By continuing to use our site, you agree to our Privacy Policy and Terms of Use. Symptoms are flu-like, including: Fever Coughing Absolute Total Care will honor those authorizations. 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. and Human Services They are called: State law allows you to make a grievance if you have any problems with us. z4M0(th`1Lf`M18c BIcJ[%4l JU2 _ s A. Providers are encouraged to sign up to receive EFT payments to avoid any payment delays. WellCare offers participating providers EFT and ERA services at no charge through PaySpan Health. Q. It will let you know we received your appeal. 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! A hearing officer from the State will decide if we made the right decision. All dates of service on or after April 1, 2021 should be filed to Absolute Total Care. Obstetrician care provided by an out of network Obstetrician will be covered for pregnant members inclusive of post-partum care. Contact Absolute Total Care Provider Service at1-866-433-6041if youhave questions. 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. All dates of service prior to 4/1/2021 should be filed to WellCare of South Carolina. Claims for services on or after April 1, 2021 should be filed to Absolute Total Care for processing. Claims Department A grievance is when you tell us about a concern you have with our plan. Select your topic and plan and click "Chat Now!" to chat with a live agent! We will do this as quickly as possible as but no longer than 72-hours from the decision. Keep yourself informed about Coronavirus (COVID-19.) You must ask within 30 calendar days of getting our decision. P.O. For current information, visit the Absolute Total Care website. 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. You now have access to a secure, quick way to electronically settle claims. You can file the grievance yourself. Need an account? Q. Attn: Grievance Department Q. WellCare of South Carolina will be known as Absolute Total Care as of 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. 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. 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. Providers can help facilitate timely claim payment by having an understanding of our processes and requirements. Ambetter Timely Filing Limit of : 1) Initial Claims. P.O. A. With the completion of this transaction, we have created a premier healthcare enterprise focused on government-sponsored healthcare programs. For the latest COVID-19 news, visit the CDC. 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. As of April 1, 2021, WellCare will no longer be a separate plan option offered by South Carolina Healthy Connections Choices. Effective January 1, 2015 the South Carolina Department of Health and Human Services (SCDHHS) will implement a Claim Reconsideration Policy. Download the free version of Adobe Reader. How do I bill a professional submission with services spanning before and after 04/01/2021? Q. Q. %PDF-1.6 % 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. Q. Providers can help facilitate timely claim payment by having an understanding of our processes and requirements. Providers interested in joining the Absolute Total Care vision network for routine vision services can contact Envolve Vision at 1-800-531-2818. Tampa, FL 33631-3372. Box 6000 Greenville, SC 29606. WellCare Medicare Advantage Claims must be filed within 180 calendar days from the date of service. Pregnant members receiving care from an out-of-network Obstetrician can continue to see their current obstetrician until after the baby is born. 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. Absolute Total Care will continue to offer Marketplace products under the Ambetter brand. If you think you might have been exposed, contact a doctor immediately. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. 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. If you wish to use a representative, then he or she must complete an Appointment of Representative (AOR) statement. 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 N .7$* P!70 *I;Rox3 ] LS~. Absolute Total Care will honor all existing WellCare authorization approvals that include dates of service beyond March 31, 2021. The Medicare portion of the agreement will continue to function in its entirety as applicable. However, as of April 1, 2021, all WellCare of South Carolina Medicaid members will become Absolute Total Care members. You can ask in writing for a State Fair Hearing (hearing, for short). If Statement Range is April 2, 2021 through April 10, 2021, please send to Absolute Total Care. A. 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. All billing requirements must be adher ed to by the provider in order to ensure timely processing of claims. Resources Claims for services prior to April 1, 2021 should be filed to WellCare for processing. 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 33631-3384. DOS prior to April 1, 2021: Processed by WellCare. Additionally, WellCare will have a migration section on their provider webpage publishing FAQs. It is called a "Notice of Adverse Benefit Determination" or "NABD." How will credentialing/recredentialing be handled by Absolute Total Care if a provider was recently credentialed/recredentialed by WellCare? Wellcare uses cookies. A. Within five business days of getting your grievance, we will mail you a letter. 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. Pharmacy services prior to April 1, 2021 must be requested from WellCare of South Carolina. Q. As of April 1, 2021, WellCare will no longer be a separate plan option offered by South Carolina Healthy Connections Choices. Contact Us Y0020_WCM_100876E Last Updated On: 10/1/2022 These grievances may be about: The state of South Carolina allows members to file a grievance at anytime from the event that caused the dissatisfaction. Your second-level review will be performed by person(s) not involved in the first review. We're here for you. South Carolina | Wellcare SOUTH CAROLINA Healthcare done well. The second level review will follow the same process and procedure outlined for the initial review. Shop or Enroll in a Plan Frequently Asked Questions Find a Doctor Download Digital ID Card Welcome Allwell Members! Will Absolute Total Care change its name to WellCare? Search for primary care providers, hospitals, pharmacies, and more! The annual flu vaccine helps prevent the flu.Protect yourself and those around you. From Date Institutional Statement Dates prior to April 1, 2021 should be filed to WellCare of South Carolina. We will give you information to help you get the most from your benefits and the services we provide. The state has also helped to set the rules for making a grievance. 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. 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. You, your friend, a relative, legal counsel or other spokesperson who has your written consent may ask for a State Fair Hearing. Please use the earliest From Date. You can also have a video visit with a doctor using your phone or computer. 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 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 Written notice is not needed if your expedited appeal request is filed verbally. Providers are encouraged to visit the Provider Resources webpagefor manuals, forms, and resources related to claims submission, eligibility, prior authorization, and more. We will send you another letter with our decision within 90 days or sooner. P.O. If Statement Range is March 14, 2021 through April 3, 2021, please send to WellCare. However, there will be no members accessing/assigned to the Medicaid portion of the agreement. Claims will be processed according to timely filing provisions in the providers Absolute Total Care Participating Provider Agreement. You must file your appeal within 60 calendar days from the date on the NABD. To have someone represent you, you must complete an Appointment of Representative (AOR) form. 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 . Will WellCare continue to offer current products or Medicare only? At the hearing, well explain why we made our decision. Refer to your particular provider type program chapter for clarification. 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.
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