You can file an appeal if you do not agree with our decision. P.O. The Claim Reconsideration process is an informal claim review, and is not a substitute for an appeal of a final agency decision. Wellcare uses cookies. The participating provider agreement with WellCare will remain in-place after April 1, 2021. A hearing officer from the State will decide if we made the right decision. DOSApril 1, 2021 and after: Processed by Absolute Total Care. Columbia, SC 29202-8206. A. If you wish to use a representative, then he or she must complete an Appointment of Representative (AOR) statement. You will need Adobe Reader to open PDFs on this site. You can ask in writing for a State Fair Hearing (hearing, for short). Contact Absolute Total Care Provider Service at1-866-433-6041if youhave questions. Please use the Earliest From Date. 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. We will also send you a letter with our decision within 72 hours from receiving your appeal. Utilize interactive health and wellness tools to help you manage conditions, improve your health and save money. 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. Members will receive a 90-day transition of care period if the member is receiving ongoing care and treatment. You, your friend, a relative, legal counsel or other spokesperson who has your written consent may ask for a State Fair Hearing. Will WellCare continue to offer current products or Medicare only? A. We expect this process to be seamless for our valued members, and there will be no break in their coverage. It is called a "Notice of Adverse Benefit Determination" or "NABD." Timely filing is when you file a claim within a payer-determined time limit. We are glad you joined our family! endstream
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As of April 1, 2021, all WellCare of South Carolina Medicaid members will become Absolute Total Care members. WellCare claims will be processed according to timely filing provisions in the providers WellCare Participating Provider Agreement. Outpatient Prior Authorization Form (PDF) Inpatient Prior Authorization Form (PDF) 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. Members can continue to receive services from their current WellCare provider as long as they remain covered under WellCare.
We will give you information to help you get the most from your benefits and the services we provide. Prior authorizations issued by WellCare for dates of service on or after 4/1/2021 will transfer with the members eligibility to Absolute Total Care. To continue providing transition of care services, providers that are not part of the Absolute Total Care network must agree to work with Absolute Total Care and accept Absolute Total Cares payment rates. 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. 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. We're here for you. Ambetter Timely Filing Limit of : 1) Initial Claims. Welcome to Wellcare By Allwell, a Medicare Advantage plan. What will happen to my Participating Provider Agreement with WellCare after 4/1/2021? We expect this process to be seamless for our valued members, and there will be no break in their coverage. Examples: If Statement Range is March 14, 2021 through April 3, 2021, please send to WellCare. A. That's why we provide tools and resources to help. Federal Employee Program (FEP) Federal Employee Program P.O. Pregnant members receiving care from an out-of-network Obstetrician can continue to see their current obstetrician until after the baby is born. Claims will be processed according to timely filing provisions in the providers Absolute Total Care Participating Provider Agreement. Absolute Total Care will honor those authorizations. Providers interested in joining the Absolute Total Care vision network for routine vision services can contact Envolve Vision at 1-800-531-2818. Absolute Total Care will continue to offer Marketplace products under the Ambetter brand. For dates of service on or after April 1, 2021: Absolute Total Care A. Members will need to talk to their provider right away if they want to keep seeing him/her. Please use the earliest From Date. A. A. We will do this as quickly as possible as but no longer than 72-hours from the decision. Absolute Total Care will honor those authorizations. Awagandakami However, as of April 1, 2021, all WellCare of South Carolina Medicaid members will become Absolute Total Care members. DOS April 1, 2021 and after: Processed by Absolute Total Care. Provider can't require members to appoint them as a condition of getting services. Farmington, MO 63640-3821. Date of Occurrence/DOSApril 1, 2021 and after: Processed by Absolute Total Care. In South Carolina, WellCare and Absolute Total Care are joining to better serve you. If an authorization is needed, you can log in to the Secure Provider Portalto submit and confirm authorizations. Claims submission, correspondence, and contact resources will stay the same for the Medicare line of business. To avoid rejections please split the services into two separate claim submissions. Wellcare uses cookies. P.O. Within five business days of getting your grievance, we will mail you a letter. WellCare Health Plans, Inc. (NYSE: WCG) is now offering a $120 credit per family, per year towards over-the-counter (OTC) items as part of its Medicaid program benefits in South Carolina. Members will receive a 90-day transition of care period if the member is receiving ongoing care and treatment. Symptoms are flu-like, including: Fever Coughing How do I bill a professional submission with services spanning before and after 04/01/2021? However, there will be no members accessing/assigned to the Medicaid portion of the agreement. If Statement Range is April 2, 2021 through April 10, 2021, please send to Absolute Total Care. The onlineProvider Manual represents the most up-to-date information on Absolute Total Cares Medicaid Plan, programs, policies, and procedures. Copyright 2023 Wellcare Health Plans, Inc. Clinical Laboratory Improvement Amendments (CLIA). Absolute Total Care will honor those authorizations. How will credentialing/recredentialing be handled by Absolute Total Care if a provider was recently credentialed/recredentialed by WellCare? This gives members time to establish with a new provider in the network and ensure that they have continuity of 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. We understand that maintaining a healthy community starts with providing care to those who need it most. Members must have Medicaid to enroll. Wellcare uses cookies. If Medicare is the primary payer, timely filing is determined from the processing date indicated on the primary carrier's explanation of benefit (EOB) If Medicare is the Secondary Payer (MSP), the initial claim must be submitted to the primary payer within Cigna's timely filing period. As of April 1, 2021, all WellCare of South Carolina Medicaid members will become Absolute Total Care members. WellCare credentialing cycles will be shared with Absolute Total Care in order to reduce duplicative credentialing in the future. Absolute Total Care will honor all existing WellCare authorization approvals that include dates of service beyond March 31, 2021. They are called: State law allows you to make a grievance if you have any problems with us. You may do this in writing or in person. Please use the From Date Institutional Statement Date. Or you can have someone file it for you. Box 31224 A. Exceptions to the one-year time limit: a) Medicare Cost Sharing Claims . 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. How are WellCare Medicaid member authorizations being handled after April 1, 2021? We will call you with our decision if we decide you need a fast appeal. We are simplifying Medicare so you can choose and use an affordable local plan that will help you achieve your best possible health. P.O. From Date Institutional Statement Dates prior to 4/1/2021 should be filed to WellCare of South Carolina. You will need Adobe Reader to open PDFs on this site. 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. This manual sets forth the policies and procedures that providers participating in the Wellcare Prime network are required tofollow. Forgot Your Password? If you need claim filing assistance, please contact your provider advocate. $8v + Yu @bAD`K@8m.`:DPeV @l Claims for services on or after April 1, 2021 should be filed to Absolute Total Care for processing. The hearing officer does not decide in your favor. A. WellCare credentialing cycles will be shared with Absolute Total Care in order to reduce duplicative credentialing in the future. To do this: Be sure to ask us to continue your benefits within the 10 calendar day time frame. If Statement Range is March 14, 2021 through April 3, 2021, please send to WellCare. Box 100605 Columbia, SC 29260. Electronic and Paper Claims Submissions; Institutional Claims/Encounter Guides. In South Carolina, WellCare and Absolute Total Care are joining to better serve you. WellCare understands that having access to the right tools can help you and your staff streamline day-to-day administrative tasks. and Human Services We try to make filing claims with us as easy as possible. In this section, we will explain how you can tell us about these concerns/grievances. This must be done within 120 days from the date of Notice of Appeal Resolution you received from us. Ambetter from Absolute Total Care - South Carolina. All dates of service on or after 4/1/2021 should be filed to Absolute Total Care. You can get many of your Coronavirus-related questions answered here. Claims will be processed according to timely filing provisions in the providers WellCare Participating Provider Agreement. * Username. A. Additionally, WellCare will have a migration section on their provider webpage publishing FAQs. UHC Community TFL - Timely filing Limit: 120 Days: Unitedhealthcare TFL - Timely filing Limit: Participating Providers: 90 days Non Participating Providers: 180 Days If its secondary payer: 90 days from date of Primary Explanation of Benefits Unitedhealthcare timely filing limit for appeals: 12 months from original claim determination To continue providing transition of care services, providers that are not part of the Absolute Total Care Network must agree to work with Absolute Total Care and accept Absolute Total Cares payment rates. Explains how to receive, load and send 834 EDI files for member information. 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. All dates of service prior to 4/1/2021 should be filed to WellCare of South Carolina. Q. 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 This manual sets forth the policies and procedures that providers participating in the Absolute Total Carenetwork are required tofollow. Claim Filing AmeriHealth Caritas North Carolina, hereafter referred to as the Plan (where appropriate), is required by the North Carolina and federal regulations to capture specific data regarding services rendered to its members. 3) Coordination of Benefits. Need an account? By continuing to use our site, you agree to our Privacy Policy and Terms of Use. To have someone represent you, you must complete an Appointment of Representative (AOR) form. You can file your appeal by calling or writing to us. You will receive an acknowledgement letter within 5 business days, and we will send you a resolution within 90 calendar days. Can I continue to see my current WellCare members? If you think you might have been exposed, contact a doctor immediately. No, Absolute Total Care will continue to operate under the Absolute Total Care name. As of April 1, 2021, WellCare will no longer be a separate plan option offered by South Carolina Healthy Connections Choices. Q. Know the facts about Coronavirus (COVID-19) Our call centers, including the nurse advice line, are currently experiencing high volume. Members will need to talk to their provider right away if they want to keep seeing him/her. Box 600601 Columbia, SC 29260. Register now at https://www.payspanhealth.comor contact PaySpan at providersupport@payspanhealth.com, or 877-331-7154. WellCare Medicare members are not affected by this change. However, there will be no members accessing/assigned to the Medicaid portion of the agreement. You may file your second level grievance review within 30 days of receiving your grievance decision letter. The state has also helped to set the rules for making a grievance. Q. This gives members time to establish with a new provider in the network and ensure that they have continuity of care. Claims for services prior to April 1, 2021 should be filed to WellCare for processing. From Date Institutional Statement Dates on or after April 1, 2021 should be filed to Absolute Total Care.