S< 2) Reconsideration or Claim disputes/Appeals. From Date Institutional Statement Dates on or after April 1, 2021 should be filed to Absolute Total Care. Q: What is Absolute Total Cares Transition/Continuity of Care Policy? How are WellCare Medicaid member authorizations being handled after April 1, 2021? If Statement Range is March 14, 2021 through April 3, 2021, please send to WellCare. Q. 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. You will need Adobe Reader to open PDFs on this site. ?-}++lz;.0U(_I]:3O'~3-~%-JM Effective January 1, 2015 the South Carolina Department of Health and Human Services (SCDHHS) will implement a Claim Reconsideration Policy. 3) Coordination of Benefits. 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. We cannot disenroll you from our plan or treat you differently. 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. You can make three types of grievances. As of April 1, 2021, WellCare will no longer be a separate plan option offered by South Carolina Healthy Connections Choices. A. Earliest From Dates prior to 4/1/2021 should be filed to WellCare of South Carolina. Reconsideration or Claim Disputes/Appeals: WellCare offers participating providers EFT and ERA services at no charge through PaySpan Health. If an authorization is needed, you can log in to the Secure Provider Portalto submit and confirm authorizations. WellCare Medicare Advantage Claims must be filed within 180 calendar days from the date of service. Register now. 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 and the person you choose to represent you must sign the AOR form. As of April 1, 2021, WellCare will no longer be a separate plan option offered by South Carolina Healthy Connections Choices. Obstetrician care provided by an out-of-network obstetrician will be covered for pregnant members inclusive of postpartum care. DOSApril 1, 2021 and after: Processed by Absolute Total Care. Payments mailed to providers are subject to USPS mailing timeframes. Obstetrician care provided by an out of network Obstetrician will be covered for pregnant members inclusive of post-partum care. Columbia, SC 29202-8206. This manual sets forth the policies and procedures that providers participating in the Wellcare Prime network are required to follow. Electronic and Paper Claims Submissions; Institutional Claims/Encounter Guides. Finding a doctor is quick and easy. Those who attend the hearing include: You can also request to have your hearing over the phone. N .7$* P!70 *I;Rox3
] LS~. That's why we provide tools and resources to help. A hearing officer from the State will decide if we made the right decision. The timely filing limit is the time duration from service rendered to patients and submitting claims to the insurance companies. 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 healthcare services starting April 1, 2021. P.O. A. WellCare of South Carolinawants to ensure that claims are handled as efficiently as possible. 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. Only you or your authorizedrepresentative can ask for a State Fair Hearing. 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. From Date Institutional Statement Dates prior to April 1, 2021 should be filed to WellCare of South Carolina. Contact Wellcare Prime Provider Service at 1-855-735-4398 if you have questions. P.O. South Carolina | Wellcare SOUTH CAROLINA Healthcare done well. 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. Claims for services prior to April 1, 2021 should be filed to WellCare for processing. 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. Absolute Total Care WellCare of North Carolina partners with providers to develop and deliver high-quality, cost-effective health care solutions. Outpatient Prior Authorization Form (PDF) Inpatient Prior Authorization Form (PDF) WellCare Medicaid members migrating to Absolute Total Care will be assigned to their assigned WellCare primary care provider as if the primary care provideris in network with Absolute Total Care. With the completion of this transaction, we have created a premier healthcare enterprise focused on government-sponsored healthcare programs. * Password. To do so by phone, call Member Services at 1-888-588-9842 (TTY1-877-247-6272). Members can continue to receive services from their current WellCare provider as long as they remain covered under WellCare. Go365 for Humana Healthy Horizons Members can register for the new Go365 for Humana Healthy Horizons wellness program and earn rewards for participating in healthy activities. We will also send you a letter with our decision within 72 hours from receiving your appeal. A. 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. Please use the From Date Institutional Statement Date. Additionally, WellCare will have a migration section on their provider page at
publishing FAQs. This must be done within 120 days from the date of Notice of Appeal Resolution you received from us. \{-w{,xI202100$0*bZf ,X AayhP3pYla" e 3G& `eoT#@ *;d
The member will be encouraged to establish care with a new in network primary care provider/specialist prior to the end of the transition/continuity of care period to review present treatment plan and coordinate the member's medical care. If you think you might have been exposed, contact a doctor immediately. We encourage you to check the Medicaid Pre-Auth Check Toolto ensure that you are accessing the most current Absolute Total Care authorization requirements for dates of service on or after April 1, 2021. Q. We welcome Brokers who share our commitment to compliance and member satisfaction. We will continue covering your medical services during your appeal request and State Fair Hearing if all of the following are meet. Please use the Earliest From Date. Explains rules and state, line of business and CMS-specific regulations regarding 837P EDI transactions. Q. We comply with applicable Federal civil rights laws and do not discriminate on the basis of race, color, national origin, age, sex, or disability. hbbd``b`$= $ Pregnant members receiving care from an out of network Obstetrician can continue to see their current Obstetrician until after the baby is born. South Carolina Department of Health and Human Services Division of Appeals and Hearings P.O. These SNP plans provide benefits beyond Original Medicare, and may include transportation to medical appointments and vision exams. Where should I submit claims for WellCare Medicaid members that transition to Absolute Total Care? Timely Filing Limits for all Insurances updated (2023) - Bcbsproviderphonenumber Timely Filing Limits for all Insurances updated (2023) One of the common and popular denials is passed the timely filing limit. WellCare of South Carolina will be known as Absolute Total Care as of April 1, 2021. With the completion of this transaction, we have created a premier healthcare enterprise focused on government-sponsored healthcare programs. Absolute Total Care will honor all existing WellCare authorization approvals that include dates of service beyond March 31, 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. At the hearing, well explain why we made our decision. You will receive an acknowledgement letter within 5 business days, and we will send you a resolution within 90 calendar days. 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. With quality healthcare solutions, Ambetter from Absolute Total Care helps residents of South Carolina live better. Welcome to Wellcare By Allwell, a Medicare Advantage plan. The provider needs to contact Absolute Total Care to arrange continuing care. Providers interested in joining the Absolute Total Care vision network for routine vision services can contact Envolve Vision at 1-800-531-2818. Box 8206 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. You must ask within 30 calendar days of getting our decision. Q. 837 Institutional Encounter 5010v Guide Download the free version of Adobe Reader. Or you can have someone file it for you. 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. With the completion of this transaction, we have created a premier healthcare enterprise focused on government-sponsored healthcare programs. We will call you with our decision if we decide you need a fast appeal. 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 you dont agree with our appeal decision - and you've completed the appeal steps with our health plan - or, if our appeal decision was not made within the required timeframe (30-calendar days for standard appeals or 72 hours for fast appeals), you may request a State Fair Hearing. As of April 1, 2021, all WellCare of South Carolina Medicaid members will become Absolute Total Care members. Box 100605 Columbia, SC 29260. As of April 1, 2021 Absolute Total Care, a Centene company, is now the health plan for South Carolina Medicaid members. Our fax number is 1-866-201-0657. How will credentialing/recredentialing be handled by Absolute Total Care if a provider was recently credentialed/recredentialed by WellCare? Send your written appeal to: We must have your written consent before someone can file an appeal for you. Will WellCare continue to offer current products or Medicare only? Box 8206 Columbia, SC 29202-8206 Or call 1-800-763-9087. 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. Wfu neebybfgnh bgWfulnybfgC South Carolina Medicaid Provider Resource Guide Thank you for being a star member of our provider team. 0
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. Wellcare uses cookies. 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. 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. All dates of service on or after 4/1/2021 should be filed to Absolute Total Care. Please Explore the Site and Get To Know Us. We will give you information to help you get the most from your benefits and the services we provide. WellCare Medicare members are not affected by this change. In South Carolina, WellCare and Absolute Total Care are joining to better serve you. If Statement Range is April 2, 2021 through April 10, 2021, please send to Absolute Total Care. Explains rules and state, line of business and CMS-specific regulations regarding 837P EDI transactions. The onlineProvider Manual represents the most up-to-date information on Absolute Total Cares Medicaid Plan, programs, policies, and procedures. You can also have a video visit with a doctor using your phone or computer. BlueCross BlueShield of South Carolina Piedmont Service Center P.O. Hearings are used when you were denied a service or only part of the service was approved. 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. 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. Federal Employee Program (FEP) Federal Employee Program P.O. 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. 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. Pharmacy services prior to April 1, 2021 must be requested from WellCare of South Carolina. Absolute Total Care will honor those authorizations. hb```b``6``e`~ "@1V
NB, Explains rules and state, line of business and CMS-specific regulations regarding 837I EDI transactions. 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 DOS April 1, 2021 and after: Processed by Absolute Total Care. P.O. 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. Date of Occurrence/DOSApril 1, 2021 and after: Processed by Absolute Total Care. the timely filing limits due to the provider being unaware of a beneficiary's coverage. All dates of service prior to April 1, 2021 should be filed to WellCare of South Carolina. Providers interested in joining the Absolute Total Care Provider Network should submit a request to Network Development and Contracting via email at. 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. As of April 1, 2021, all WellCare of South Carolina Medicaid members will transfer to Absolute Total Care. PROVIDERS NOTE:Please send Corrected Claims as normal submissions via electronic or paper. 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? #~0 I
Q. Or it can be made if we take too long to make a care decision. As of April 1, 2021, all WellCare of South Carolina Medicaid members will transfer to Absolute Total Care. Coronavirus Disease 2019 (COVID-19) causes respiratory illness in people and can spread from person to person. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. You, your friend, a relative, legal counsel or other spokesperson who has your written consent may ask for a State Fair Hearing. The annual flu vaccine helps prevent the flu.Protect yourself and those around you. Wellcare uses cookies. Absolute Total Care will honor those authorizations. The rules include what we must do when we get a grievance.
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