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Explains how to receive, load and send 834 EDI files for member information. If you are unable to view PDFs, please download Adobe Reader. The annual flu vaccine helps prevent the flu.Protect yourself and those around you. Provider can't require members to appoint them as a condition of getting services. Pharmacy services prior to April 1, 2021 must be requested from WellCare of South Carolina. Explains rules and state, line of business and CMS-specific regulations regarding 837P EDI transactions. If Statement Range is April 2, 2021 through April 10, 2021, please send to Absolute Total Care. This manual sets forth the policies and procedures that providers participating in the Absolute Total Carenetwork are required tofollow. Electronic and Paper Claims Submissions; Institutional Claims/Encounter Guides. Earliest From Dates on or after April 1, 2021 should be filed to Absolute Total Care. How do I bill a professional submission with services spanning before and after 04/01/2021? A hearing officer from the State will decide if we made the right decision. If you dont, we will have to deny your request. (This includes your PCP or another provider.) It was a smart move. 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. Claims for services prior to April 1, 2021 should be filed to WellCare for processing. Wfu neebybfgnh bgWfulnybfgC South Carolina Medicaid Provider Resource Guide Thank you for being a star member of our provider team. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. Division of Appeals and Hearings Our fax number is 1-866-201-0657. To earn rewards, members must: Download the Go365 for Humana Healthy Horizons app onto a mobile device from the Apple App Store or Google Play. 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. Please use the earliest From Date. The Medicare portion of the agreement will continue to function in its entirety as applicable. Timely filing limits vary. You and the person you choose to represent you must sign the AOR statement. 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. Utilize interactive health and wellness tools to help you manage conditions, improve your health and save money. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. A. The Claim Reconsideration process is an informal claim review, and is not a substitute for an appeal of a final agency decision. To write us, send mail to: You can fax it too. State Health Plan State Claims P.O. From Date Institutional Statement Dates on or after 4/1/2021 should be filed to Absolute Total Care. Claims for services on or after April 1, 2021 should be filed to Absolute Total Care for processing. Explains rules and state, line of business and CMS-specific regulations regarding 837P EDI transactions. 2) Reconsideration or Claim disputes/Appeals. Timely Filing Limit: Timely Filing Limit is the time frame set by insurance companies and provider has to submit health care claims to respective insurance company within the set time frame for reimbursement of the claims. Section 1: General Information. ?-}++lz;.0U(_I]:3O'~3-~%-JM They are called: State law allows you to make a grievance if you have any problems with us. 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. Member Sign-In. You can make three types of grievances. Absolute Total Care will honor all existing WellCare authorization approvals that include dates of service beyond March 31, 2021. Members must have Medicaid to enroll. 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. Yes, Absolute Total Care and WellCare will continue to offer Medicare products under their current brands and product names, until further notice. For dates of service on or after April 1, 2021: Absolute Total Care Wellcare uses cookies. Awagandakami Your second-level review will be performed by person(s) not involved in the first review. 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. You may do this in writing or in person. How do I determine if an institutional inpatient bill type submission overlapping 4/1/2021 should be filed to WellCare or Absolute Total Care? Copyright 2023 Wellcare Health Plans, Inc. Our health insurance programs are committed to transforming the health of the community one individual at a time. As of April 1, 2021, all WellCare of South Carolina Medicaid members will become Absolute Total Care members. There is a lot of insurance that follows different time frames for claim submission. Providers interested in joining the Absolute Total Care Provider Network should submit a request to Network Development and Contracting via email at. To avoid rejections please split the services into two separate claim submissions. From Date Institutional Statement Dates prior to 4/1/2021 should be filed to WellCare of South Carolina. We expect this process to be seamless for our valued members and there will be no break in their coverage. Pharmacy services prior to 4/1/2021 must be requested from WellCare South Carolina. 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. 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 will get a letter from us when any of these actions occur. The hearing officer will decide whether our decision was right or wrong. On June 19, 2018, the Family and Social Services Administration's ("FSSA") Indiana Health Coverage Programs ("IHCP") released provider bulletin BT201829 regarding revising the timely filing limit for Medicaid fee-for-service claims. Or it can be made if we take too long to make a care decision. Q. A. Our call centers, including the nurse advice line, are currently experiencing high volume. 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. Contact Us Y0020_WCM_100876E Last Updated On: 10/1/2022 If an authorization is needed, you can log in to the Secure Provider Portal at absolutetotalcare.com to submit and confirm authorizations. However, as of April 1, 2021, all WellCare of South Carolina Medicaid members will become Absolute Total Care members. Keep yourself informed about Coronavirus (COVID-19.) WellCare claims will be processed according to timely filing provisions in the providers WellCare Participating Provider Agreement. L]4(f4/pn~YTZSp-5/O*F)e~p:a6o{x8r The Medicare portion of the agreement will continue to function in its entirety as applicable. More Information Need help? We expect this process to be seamless for our valued members, and there will be no break in their coverage. Initial Claims: 120 Days from the Date of Service. Claims for services prior to April 1, 2021 should be filed to WellCare for processing. You can ask for a State Fair Hearing after we make our appeal decision. Continuation of Benefits During the Appeals Process We will continue covering your medical services during your appeal request and State Fair Hearing if all of the following are meet. More Information Coronavirus (COVID-19) Providers can help facilitate timely claim payment by having an understanding of our processes and requirements. We expect this process to be seamless for our valued members, and there will be no break in their coverage. No, Absolute Total Care will continue to operate under the Absolute Total Care name. With the completion of this transaction, we have created a premier healthcare enterprise focused on government-sponsored healthcare programs. A. 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. Can I continue to see my current WellCare members? 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. If you think you might have been exposed, contact a doctor immediately. 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. WellCare of South Carolina will be known as Absolute Total Care as of April 1, 2021. WellCare understands that having access to the right tools can help you and your staff streamline day-to-day administrative tasks. WellCare and Absolute Total Care Medicare plans will continue to operate under current brands, product names and provider contracts, until further notice. All dates of service on or after 4/1/2021 should be filed to Absolute Total Care. Providers can begin requesting prior authorization from Absolute Total Care for dates of service on or after 4/1/2021 from Absolute Total Care on, 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. Earliest From Dates on or after 4/1/2021 should be filed to Absolute Total Care. 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. 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. Wellcare uses cookies. Hearings are used when you were denied a service or only part of the service was approved. 0 WellCare is the health care plan that puts you in control. Date of Occurrence/DOSprior toApril 1, 2021: Processed by WellCare. We try to make filing claims with us as easy as possible. 2023 Medicare and PDP Compare Plans and Enroll Now. Pregnant members receiving care from an out of network Obstetrician can continue to see their current Obstetrician until after the baby is born. WellCare claims will be processed according to timely filing provisions in the providers WellCare Participating Provider Agreement. We expect this process to be seamless for our valued members and there will be no break in their coverage. P.O. Absolute Total Care will continue to offer Marketplace products under the Ambetter brand. We would like to help your billing department get your EDI (claims and real time) transactions processed as efficiently as possible. A. You may request a State Fair Hearing at this address: South Carolina Department of Health This manual sets forth the policies and procedures that providers participating in the Wellcare Prime network are required tofollow. 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. #~0 I z4M0(th`1Lf`M18c BIcJ[%4l JU2 _ s South Carolina Department of Health and Human Services Division of Appeals and Hearings P.O. 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.