It is 30 days to 1 year and more and depends on . Thanka kaa yoa Tufrbeau ingsnh ngetfu South Caralaita nouMa mpvd. Beginning. WellCare Medicare members are not affected by this change. 2) Reconsideration or Claim disputes/Appeals. DOSApril 1, 2021 and after: Processed by Absolute Total Care. 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 . Wellcare uses cookies. Wellcare uses cookies. A grievance is when you tell us about a concern you have with our plan. Your second-level review will be performed by person(s) not involved in the first review. 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. 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. 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 B^E{h#XYQv;[ny3Hha1yx4v.sBy jWacQzyL.kHhwtQ~35!Rh#)p+sj31LcC)4*Z:IWIG@WTD- )n,! Where should I submit claims for WellCare Medicaid members that transition to Absolute Total Care? If an authorization is needed, you can log in to the Secure Provider Portalto submit and confirm authorizations. To avoid rejections please split the services into two separate claim submissions. 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. How will credentialing/recredentialing be handled by Absolute Total Care if a provider was recently credentialed/recredentialed by WellCare? the timely filing limits due to the provider being unaware of a beneficiary's coverage. Absolute Total Care will honor those authorizations. The Claim Reconsideration process is an informal claim review, and is not a substitute for an appeal of a final agency decision. We will do this as quickly as possible as but no longer than 72-hours from the decision. To do this: Be sure to ask us to continue your benefits within the 10 calendar day time frame. The onlineProvider Manual represents the most up-to-date information on Absolute Total Cares Medicaid Plan, programs, policies, and procedures. How do I determine if a professional or an outpatient bill type institutional submission should be filed to WellCare or Absolute Total Care? Please contact our Provider Services Call Center at 1-888-898-7969. 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. 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. 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. N .7$* P!70 *I;Rox3 ] LS~. Please Explore the Site and Get To Know Us. To write us, send mail to: You can fax it too. We must have your written permission before someone can file a grievance for you. S< The timely filing limit is the time duration from service rendered to patients and submitting claims to the insurance companies. Q. hYnH~}9'I`@>cLq,&DYH"W~&eJx'"luWU]JDBFRJ!*SN(s'6# ^*dg4$SB7K4z:r6')baka+Raf4J=)l, _/jaSpao69&&_Ln=?/{:,'z .1J0|~jv4[eUN{:-gl! K'&hng?y},&X/|OzcJ@0PhDiO})9RA9tG%=|rBhHBz7 Absolute Total Care will honor all existing WellCare authorization approvals that include dates of service beyond March 31, 2021. If you think you might have been exposed, contact a doctor immediately. Farmington, MO 63640-3821. All dates of service prior to 4/1/2021 should be filed to WellCare of South Carolina. Members will receive a 90-day transition of care period if the member is receiving ongoing care and treatment. South Carolina | Wellcare SOUTH CAROLINA Healthcare done well. 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. That's why we provide tools and resources to help. 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. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. Learn more about how were supporting members and providers. Section 1: General Information. The annual flu vaccine helps prevent the flu.Protect yourself and those around you. Wellcare uses cookies. 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 You can also have a video visit with a doctor using your phone or computer. The member will be encouraged to establish care with a new in network primary care provider/specialist prior to the end of the transition/continuity of care period to review present treatment plan and coordinate the member's medical care. Know the facts about Coronavirus (COVID-19) Our call centers, including the nurse advice line, are currently experiencing high volume. We welcome Brokers who share our commitment to compliance and member satisfaction. To have someone represent you, you must complete an Appointment of Representative (AOR) form. 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. 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. Ancillary Claims Filing Reminders; ClaimsXten TM: Correct Coding Initiative Reference Guide; Inpatient Non-Reimbursable Charges/Unbundling Policy Claims Department Select Health Claims must be filed within 12 months from the date of service. 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. If Statement Range is April 2, 2021 through April 10, 2021, please send to Absolute Total Care. DOS prior toApril 1, 2021: Processed by WellCare. Box 6000 Greenville, SC 29606. All billing requirements must be adher ed to by the provider in order to ensure timely processing of claims. Will Absolute Total Care change its name to WellCare? * Username. No, Absolute Total Care will continue to operate under the Absolute Total Care name. Example of how to properly split claim that span the cutover date of April 1, 2021: Yes, Absolute Total Care and WellCare will continue to offer Medicare products under their current brands and product names, until further notice. Providers can help facilitate timely claim payment by having an understanding of our processes and requirements. P.O. First Choice can accept claim submissions via paper or electronically (EDI). A. 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. 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. You now have access to a secure, quick way to electronically settle claims. 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. Box 8206 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? You will receive an acknowledgement letter within 5 business days, and we will send you a resolution within 90 calendar days. What will happen to unresolved claims prior to the membership transfer? Box 8206 Columbia, SC 29202-8206 Or call 1-800-763-9087. WellCare is the health care plan that puts you in control. pst/!+ Y^Ynwb7tw,eI^ We encourage you to check the Medicaid Pre-Auth Check Tool in the For Providers section on the Absolute Total Care website at absolutetotalcare.com to ensure that you are accessing the most current Absolute Total Care authorization requirements for dates of service on or after 4/1/2021. Providers will continue to follow WellCares Medicaid policies and procedures for services provided to WellCare Medicaid members for dates of service prior to April 1, 2021. You can do this at any time during your appeal. Claims Department WellCare offers participating providers EFT and ERA services at no charge through PaySpan Health. %%EOF Guides Filing Claims with WellCare. Where should I submit claims for WellCare Medicaid members? Member Appeals (Medical, Behavioral Health, and Pharmacy): You will need Adobe Reader to open PDFs on this site. * Password. Contact Us Y0020_WCM_100876E Last Updated On: 10/1/2022 The member will be encouraged to establish care with a new in network PCP/specialist prior to the end of the transition/continuity of care period to review present treatment plan and coordinate the member's medical care. An appeal may be filed within 60 calendar days from the date on the Adverse Benefit Determination Notice. 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. March 14-March 31, 2021, please send to WellCare. Q. We expect this process to be seamless for our valued members, and there will be no break in their coverage. %PDF-1.6 % 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.