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. For dates of service prior to April 1, 2021: All paper claim submissions can be mailed to: WellCare Health Plans To avoid rejections please split the services into two separate claim submissions. You can file a grievance by calling or writing to us. How do I determine if an institutional inpatient bill type submission overlapping 4/1/2021 should be filed to WellCare or Absolute Total Care? The hearing officer will decide whether our decision was right or wrong. Kasapulam ti tulong? Learn how you can help keep yourself and others healthy. How do I bill a professional submission with services spanning before and after 04/01/2021? You can also have a video visit with a doctor using your phone or computer. Shop or Enroll in a Plan Frequently Asked Questions Find a Doctor Download Digital ID Card Welcome Allwell Members! As of April 1, 2021, all WellCare of South Carolina Medicaid members will transfer to Absolute Total Care. Learn how you can help keep yourself and others healthy. Box 3050 Claims will be processed according to timely filing provisions in the providers WellCare Participating Provider Agreement. 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 Members can continue to receive services from their current WellCare provider as long as they remain covered under WellCare. Contact Wellcare Prime Provider Service at1-855-735-4398if youhave questions. March 14-March 31, 2021, please send to WellCare. Those who attend the hearing include: You can also request to have your hearing over the phone. 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 avoid rejections please split the services into two separate claim submissions. 1044 0 obj <> endobj By continuing to use our site, you agree to our Privacy Policy and Terms of Use. We welcome Brokers who share our commitment to compliance and member satisfaction. The Medicare portion of the agreement will continue to function in its entirety as applicable. Explains how to receive, load and send 834 EDI files for member information. You will get a letter from us when any of these actions occur. Search for primary care providers, hospitals, pharmacies, and more! Professional and Institutional Fee-For-Service EDI transactions should be submitted to WellCare of South Carolina Medicaid with Payer ID 14163. A. The Medicare portion of the agreement will continue to function in its entirety as applicable. Here you will find the tools and resources you need to help manage your submission of claims and receipt of payments. Instructions on how to submit a corrected or voided claim. Providers are encouraged to sign up to receive EFT payments to avoid any payment delays. Symptoms are flu-like, including: Fever Coughing WellCare credentialing cycles will be shared with Absolute Total Care in order to reduce duplicative credentialing in the future. Explains rules and state, line of business and CMS-specific regulations regarding 837P EDI transactions. pst/!+ Y^Ynwb7tw,eI^ Date of Occurrence/DOSprior toApril 1, 2021: Processed by WellCare. 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. Or it can be made if we take too long to make a care decision. The materials located on our website are for dates of service prior to April 1, 2021. 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. Providers can help facilitate timely claim payment by having an understanding of our processes and requirements. Wellcare uses cookies. Here are some guides we created to help you with claims filing. Absolute Total Care will honor those authorizations. and Human Services endstream endobj startxref The timely filing limit is the time duration from service rendered to patients and submitting claims to the insurance companies. Q. Will Absolute Total Care continue to offer Medicare and Marketplace products? 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. However, there will be no members accessing/assigned to the Medicaid portion of the agreement. A hearing officer from the State will decide if we made the right decision. Refer to your particular provider type program chapter for clarification. Welcome to Wellcare By Allwell, a Medicare Advantage plan. 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. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. ?-}++lz;.0U(_I]:3O'~3-~%-JM Explains rules and state, line of business and CMS-specific regulations regarding 837P EDI transactions. Q. Q. Please Explore the Site and Get To Know Us. 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. 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. If you need claim filing assistance, please contact your provider advocate. Wfu neebybfgnh bgWfulnybfgC South Carolina Medicaid Provider Resource Guide Thank you for being a star member of our provider team. You or your provider must call or fax us to ask for a fast appeal. We will give you information to help you get the most from your benefits and the services we provide. Initial Claims: 120 Days from the Date of Service. 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. Example of how to properly split claim that span the cutover date of April 1, 2021: Q. Professional and Institutional Fee-For-Service EDI transactions should be submitted to WellCare of South Carolina Medicaid with Payer ID 14163. 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! Q. 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 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. Tampa, FL 33631-3384. The Medicare portion of the agreement will continue to function in its entirety as applicable. We expect this process to be seamless for our valued members, and there will be no break in their coverage. With the completion of this transaction, we have created a premier healthcare enterprise focused on government-sponsored healthcare programs. Wellcare uses cookies. WellCare of North Carolina will begin to release medical payments to providers beginning July 6, 2021. WellCare claims will be processed according to timely filing provisions in the providers WellCare Participating Provider Agreement. 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. 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. 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. Electronic and Paper Claims Submissions; Institutional Claims/Encounter Guides. Within five business days of getting your grievance, we will mail you a letter. Q. APPEALS, GRIEVANCES AND PROVIDER DISPUTES. We are simplifying Medicare so you can choose and use an affordable local plan that will help you achieve your best possible health. 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. (This includes your PCP or another provider.) You may do this in writing or in person. 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. Select your topic and plan and click "Chat Now!" to chat with a live agent! These SNP plans provide benefits beyond Original Medicare, and may include transportation to medical appointments and vision exams. 8h} \x p`03 1z`@+`~70 G ~Ws5Puick79,4 ,O5@?O-Gr'|5Oj:v6/` Please use the From Date Institutional Statement Date. 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. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. Section 1: General Information. 3) Coordination of Benefits. 941w*)bF iLK\c;nF mhk} Members can continue to receive services from their current WellCare provider as long as they remain covered under WellCare. DOS April 1, 2021 and after: Processed by Absolute Total Care. For additional information, questions or concerns, please contact your local Provider Network Management Representative. As of April 1, 2021, all WellCare of South Carolina Medicaid members will transfer to Absolute Total Care. You can ask in writing for a State Fair Hearing (hearing, for short). Authorizations already processed by WellCare for any services on or after April 1, 2021, will be moved to Absolute Total Care and there is no need for the provider or member to request these services again. From Date Institutional Statement Dates prior to 4/1/2021 should be filed to WellCare of South Carolina. We process check runs daily, with the exception of Sundays, National Holidays, and the last day of the month. Resources Wellcare uses cookies. Claims submission, correspondence, and contact resources will stay the same for the Medicare line of business. 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. 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? Q. It is 30 days to 1 year and more and depends on . 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. We will call you with our decision if we decide you need a fast appeal. 2) Reconsideration or Claim disputes/Appeals. If you request a hearing, the request must: A State Fair Hearing is a legal proceeding. A. Member Appeals (Medical, Behavioral Health, and Pharmacy): You will need Adobe Reader to open PDFs on this site. What is the Rx BIN and Group Number for WellCare members transitioning to Absolute Total Care on April 1, 2021? You can file an appeal if you do not agree with our decision. Pregnant members receiving care from an out-of-network Obstetrician can continue to see their current obstetrician until after the baby is born. 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. 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. Timely Filing Beginning October 1, 2020, the Timely Filing submission requirements specified in each Provider's Meridian Medicare contract will be enforced. Download the free version of Adobe Reader. Will WellCare continue to offer current products or Medicare only? 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. Get an annual flu shot today. 837 Institutional Encounter 5010v Guide You can get many of your Coronavirus-related questions answered here. Know the facts about Coronavirus (COVID-19) Our call centers, including the nurse advice line, are currently experiencing high volume. 2023 Medicare and PDP Compare Plans and Enroll Now. As of April 1, 2021, WellCare will no longer be a separate plan option offered by South Carolina Healthy Connections Choices. 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. Absolute Total Care will continue to offer Marketplace products under the Ambetter brand. Can I continue to see my current WellCare members? A. With the completion of this transaction, we have created a premier healthcare enterprise focused on government-sponsored healthcare programs. WellCare and Absolute Total Care Medicare plans will continue to operate under current brands, product names and provider contracts, until further notice. Division of Appeals and Hearings The Claim Reconsideration process is an informal claim review, and is not a substitute for an appeal of a final agency decision. A. 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. Absolute Total Care will honor those authorizations. You now have access to a secure, quick way to electronically settle claims. Absolute Total Care will honor all existing WellCare authorization approvals that include dates of service beyond March 31, 2021. Q. We will review it and send you a decision letter within 30 calendar days from receiving your appeal. Member Sign-In. At WellCare, we value everything you do to deliver quality care to our members your patients and ensure they have a positive health care experience. 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.
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