Please use the From Date Institutional Statement Date. 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. 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. 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. Managed Care Claims and Prior Authorizations Submission - NCDHHS 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 Providers can help facilitate timely claim payment by having an understanding of our processes and requirements. All dates of service on or after 4/1/2021 should be filed to Absolute Total Care. The annual flu vaccine helps prevent the flu. 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. 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. Claims will be processed according to timely filing provisions in the providers WellCare Participating Provider Agreement. As of April 1, 2021, WellCare will no longer be a separate plan option offered by South Carolina Healthy Connections Choices. WellCare of South Carolina will be known as Absolute Total Care as of April 1, 2021. 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. Select your topic and plan and click "Chat Now!" to chat with a live agent! All dates of service prior to April 1, 2021 should be filed to WellCare of South Carolina. 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. However, as of April 1, 2021, all WellCare of South Carolina Medicaid members will become Absolute Total Care members. Wellcare wants to ensure that claims are handled as efficiently as possible. You or your authorized representative will tell the hearing officer why you think we made the wrong decision. Check out the Interoperability Page to learn more. 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. Your second-level review will be performed by person(s) not involved in the first review. Here you will find the tools and resources you need to help manage your submission of claims and receipt of payments. 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. We comply with applicable Federal civil rights laws and do not discriminate on the basis of race, color, national origin, age, sex, or disability. Will my existing WellCare patients be assigned to my Absolute Total Care Panel? It will let you know we received your appeal. The annual flu vaccine helps prevent the flu.Protect yourself and those around you. We are simplifying Medicare so you can choose and use an affordable local plan that will help you achieve your best possible health. Providers are encouraged to sign up to receive EFT payments to avoid any payment delays. Only you or your authorizedrepresentative can ask for a State Fair Hearing. 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. Explains rules and state, line of business and CMS-specific regulations regarding 837I EDI transactions. BlueCross BlueShield of South Carolina Piedmont Service Center P.O. Copyright 2023 WellCare Health Plans, Inc. WellCare Non-Emergency Medical Transportation (NEMT) Update, Provider Self-Service Quick Reference Guide (PDF), Provider Masters Level Proposed Rates (PDF), Member Advisory Committee (MAC) Member Flyer (PDF), Member Advisory Committee (MAC) - LTSS Member Flyer (PDF), Managed Care PHP Member PCP Change Request Form (PDF), Provider Referral Form: LTSS Request for PCS Assessment (PDF). Beginning. Overview & Resources WellCare of North Carolina partners with providers to develop and deliver high-quality, cost-effective health care solutions. P.O. 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 Q. Claims - Wellcare NC By continuing to use our site, you agree to our Privacy Policy and Terms of Use. 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 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. At the hearing, well explain why we made our decision. We must have your written permission before someone can file a grievance for you. 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. Or it can be made if we take too long to make a care decision. Professional and Institutional Encounter EDI transactions should be submitted to WellCare of South Carolina Medicaid with Payer ID 59354. 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. In South Carolina, WellCare and Absolute Total Care are joining to better serve you. A. A. 8h} \x p`03 1z`@+`~70 G ~Ws5Puick79,4 ,O5@?O-Gr'|5Oj:v6/` As of April 1, 2021, all WellCare of South Carolina Medicaid members will become Absolute Total Care members. Farmington, MO 63640-3821. 2023 Medicare and PDP Compare Plans and Enroll Now Notice of Non-Discrimination We comply with applicable Federal civil rights laws and do not discriminate on the basis of race, color, national origin, age, sex, or disability. Division of Appeals and Hearings Yes, Absolute Total Care and WellCare will continue to offer Medicare products under their current brands and product names, until further notice. 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. South Carolina Medicaid & Health Insurance | Absolute Total Care WellCare and Absolute Total Care Medicare plans will continue to operate under current brands, product names and provider contracts, until further notice. This manual sets forth the policies and procedures that providers participating in the Absolute Total Carenetwork are required tofollow. 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. Claims Department A. Know the facts about Coronavirus (COVID-19) Our call centers, including the nurse advice line, are currently experiencing high volume. Please contact our Provider Services Call Center at 1-888-898-7969. Refer to your particular provider type program chapter for clarification. Absolute Total Care will honor those authorizations. 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. If Statement Range is April 2, 2021 through April 10, 2021, please send to Absolute Total Care. You and the person you choose to represent you must sign the AOR statement. We want to ensure that claims are handled as efficiently as possible. 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. Q. The provider needs to contact Absolute Total Care to arrange continuing care. Our health insurance programs are committed to transforming the health of the community one individual at a time. To do this: Medicaid Claims Payment Policies %%EOF Wfu neebybfgnh bgWfulnybfgC South Carolina Medicaid Provider Resource Guide Thank you for being a star member of our provider team. DOSApril 1, 2021 and after: Processed by Absolute Total Care. Those who attend the hearing include: You can also request to have your hearing over the phone. To avoid rejections please split the services into two separate claim submissions. Providers FAQs | Wellcare z4M0(th`1Lf`M18c BIcJ[%4l JU2 _ s Always verify timely filing requirements with the third party payor. Wellcare uses cookies. To avoid rejections please split the services into two separate claim submissions. 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.
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