First Choice can accept claim submissions via paper or electronically (EDI). WellCare of North Carolina will begin to release medical payments to providers beginning July 6, 2021. What will happen to my Participating Provider Agreement with WellCare after 4/1/2021? * Password. 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. WellCare of South Carolina will be known as Absolute Total Care as of April 1, 2021. If an authorization is needed, you can log in to the Secure Provider Portalto submit and confirm authorizations. Q. An appeal may be filed within 60 calendar days from the date on the Adverse Benefit Determination Notice. This manual sets forth the policies and procedures that providers participating in the Wellcare Prime network are required to follow. We process check runs daily, with the exception of Sundays, National Holidays, and the last day of the month. Wellcare uses cookies. 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. Wellcare uses cookies. A. We will call you with our decision if we decide you need a fast appeal. With the completion of this transaction, we have created a premier healthcare enterprise focused on government-sponsored healthcare programs. 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. S< 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 . 2) Reconsideration or Claim disputes/Appeals. 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. Please contact our Provider Services Call Center at 1-888-898-7969. They are called: State law allows you to make a grievance if you have any problems with us. All dates of service on or after April 1, 2021 should be filed to Absolute Total Care. Q. We would like to help your billing department get your EDI (claims and real time) transactions processed as efficiently as possible. Utilize interactive health and wellness tools to help you manage conditions, improve your health and save money. 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. Claims for services prior to April 1, 2021 should be filed to WellCare for processing. Earliest From Dates on or after 4/1/2021 should be filed to Absolute Total Care. We will do this as quickly as possible as but no longer than 72-hours from the decision. Please note - a representative may file for a member who: If the members request for appeal is submitted after 60 calendar days from the date on the NABD, then good cause must be shown in order for WellCare to accept the late request. We will review it and send you a decision letter within 30 calendar days from receiving your appeal. 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. Contact Wellcare Prime Provider Service at 1-855-735-4398 if you have questions. You will need Adobe Reader to open PDFs on this site. (This includes your PCP or another provider.) 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. Members will receive a 90-day transition of care period if the member is receiving ongoing care and treatment. It will tell you we received your grievance. 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. As of April 1, 2021, all WellCare of South Carolina Medicaid members will become Absolute Total Care members. 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. 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. L]4(f4/pn~YTZSp-5/O*F)e~p:a6o{x8r Claims will be processed according to timely filing provisions in the providers Absolute Total Care Participating Provider Agreement. 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. 1,flQ*!WLOmsmz\D;I5BI,yA#z!vYQi5'fedREF40 b666q1(UtUJJ.i` (T/@E We comply with applicable Federal civil rights laws and do not discriminate on the basis of race, color, national origin, age, sex, or disability. P.O. Farmington, MO 63640-3821. 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. It was a smart move. To do this: Be sure to ask us to continue your benefits within the 10 calendar day time frame. If you are unable to view PDFs, please download Adobe Reader. 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. The participating provider agreement with WellCare will remain in-place after 4/1/2021. Obstetrician care provided by an out-of-network obstetrician will be covered for pregnant members inclusive of postpartum care. \{-w{,xI202100$0*bZf ,X AayhP3pYla" e 3G& `eoT#@ *;d P.O. You will have a limited time to submit additional information for a fast appeal. WellCare offers participating providers EFT and ERA services at no charge through PaySpan Health. Earliest From Dates prior to April 1, 2021 should be filed to WellCare of South Carolina. Explains rules and state, line of business and CMS-specific regulations regarding 837P EDI transactions. It will let you know we received your appeal. Professional and Institutional Encounter EDI transactions should be submitted to WellCare of South Carolina Medicaid with Payer ID 59354. For dates of service on or after April 1, 2021: Absolute Total Care We will notify you orally and in writing. Additionally, WellCare will have a migration section on their provider page at publishing FAQs. Box 6000 Greenville, SC 29606. However, as of April 1, 2021, all WellCare of South Carolina Medicaid members will become Absolute Total Care members. We are proud to announce that WellCare is now part of the Centene Family. PROVIDERS NOTE:Please send Corrected Claims as normal submissions via electronic or paper. Date of Occurrence/DOSprior toApril 1, 2021: Processed by WellCare. Member Sign-In. More Information Coronavirus (COVID-19) Providers are encouraged to visit the Provider Resources webpageformanuals, forms, clinical policies, payment policies, provider news and resources related to claims submission, eligibility, prior authorization and more. 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. Explains rules and state, line of business and CMS-specific regulations regarding 837I EDI transactions. Payments mailed to providers are subject to USPS mailing timeframes. How will credentialing/recredentialing be handled by Absolute Total Care if a provider was recently credentialed/recredentialed by WellCare? These SNP plans provide benefits beyond Original Medicare, and may include transportation to medical appointments and vision exams. Download the free version of Adobe Reader. R 1/70.3/Determining End Date of Timely Filing Period -- Receipt Date R 1/70.4/Determination of Untimely Filing and Resulting Actions R 1/70.5/Application to Special Claim Types R 1/70.6/Filing Claim Where General Time Limit Has Expired R 1/70.7/Exceptions Allowing Extension of Time Limit R 1/70.7.1/Administrative Error WellCare credentialing cycles will be shared with Absolute Total Care in order to reduce duplicative credentialing in the future. the timely filing limits due to the provider being unaware of a beneficiary's coverage. Learn how you can help keep yourself and others healthy. 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. 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. UnitedHealthcare Dual Complete Special Needs Plan UnitedHealthcare Dual Complete Special Needs Plans (SNP) offer benefits for people with both Medicare and Medicaid. With the completion of this transaction, we have created a premier healthcare enterprise focused on government-sponsored healthcare programs. Will WellCare continue to offer current products or Medicare only? 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. Box 3050 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. Claims for services on or after April 1, 2021 should be filed to Absolute Total Care for processing. Q. April 1-April 3, 2021, please send to Absolute Total Care. and Human Services 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? A provider can act for a member in hearings with the member's written permission in advance. Copyright 2023 Wellcare Health Plans, Inc. WellCare of South Carolina will be known as Absolute Total Care as of April 1, 2021. All dates of service prior to 4/1/2021 should be filed to WellCare of South Carolina. WellCare offers participating providers EFT and ERA services at no charge through PaySpan Health. 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. 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. 1096 0 obj <>stream Reimbursement Policies For the death or injury of a member of the South Carolina National Guard, as provided for in Section 42-7-67, the time for filing a claim is two years after the accident or one year after the federal claim is finalized, whichever is later. Federal Employee Program (FEP) Federal Employee Program P.O. Box 31224 Claims for services on or after April 1, 2021 should be filed to Absolute Total Care for processing. If Statement Range is April 2, 2021 through April 10, 2021, please send to Absolute Total Care. 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. People of all ages can be infected. Please use the From Date Institutional Statement Date. 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. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. If you wish to use a representative, then he or she must complete an Appointment of Representative (AOR) statement. Provider can't require members to appoint them as a condition of getting services. Box 31224 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 vision network for routine vision services can contact Envolve Vision at 1-800-531-2818. Get an annual flu shot today. Register now at https://www.payspanhealth.comor contact PaySpan at providersupport@payspanhealth.com, or 877-331-7154. Medicaid Claims Payment Policies WellCare is the health care plan that puts you in control. 2023 Medicare and PDP Compare Plans and Enroll Now. 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. What will happen to unresolved claims prior to the membership transfer? You can also have a video visit with a doctor using your phone or computer. We may apply a 14 day extension to your grievance resolution. March 14-March 31, 2021, please send to WellCare. Claims submission, correspondence, and contact resources will stay the same for the Medicare line of business. You can ask for a State Fair Hearing after we make our appeal decision. Overview & Resources WellCare of North Carolina partners with providers to develop and deliver high-quality, cost-effective health care solutions. The onlineProvider Manual represents the most up-to-date information on Wellcare Prime by Absolute Total Care (Medicare-Medicaid Plan), programs, policies, and procedures. From Date Institutional Statement Dates on or after April 1, 2021 should be filed to Absolute Total Care. Member Appeals (Medical, Behavioral Health, and Pharmacy): You will need Adobe Reader to open PDFs on this site. 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. Additionally, WellCare will have a migration section on their provider webpage publishing FAQs. Box 600601 Columbia, SC 29260. 1044 0 obj <> endobj From Date Institutional Statement Dates on or after 4/1/2021 should be filed to Absolute Total Care. For the latest COVID-19 news, visit the CDC. South Carolina Department of Health and Human Services Division of Appeals and Hearings P.O. Box 8206 Columbia, SC 29202-8206 Or call 1-800-763-9087. As of April 1, 2021, all WellCare of South Carolina Medicaid members will become Absolute Total Care members. Beginning, March 14 March 31, 2021, please send to WellCare, April 1 April 3, 2021, please send to Absolute Total Care, DOS prior to 4/1/2021- Processed by WellCare, DOS 4/1/2021 and after- Processed by Absolute Total Care, Date of Occurrence/DOS prior to 4/1/2021- Processed by WellCare, Date of Occurrence/DOS 4/1/2021 and after- Processed by Absolute Total Care. Pregnant members receiving care from an out-of-network Obstetrician can continue to see their current obstetrician until after the baby is born. Where should I submit claims for WellCare Medicaid members that transition to Absolute Total Care? Box 31384 By continuing to use our site, you agree to our Privacy Policy and Terms of Use. Forgot Your Password? In South Carolina, WellCare and Absolute Total Care are joining to better serve you. Ambetter Timely Filing Limit of : 1) Initial Claims. There is a lot of insurance that follows different time frames for claim submission. %%EOF North Carolina PHP Billing Guidance for Local W Code. Providers can help facilitate timely claim payment by having an understanding of our processes and requirements. Q. P.O. WellCare understands that having access to the right tools can help you and your staff streamline day-to-day administrative tasks. Explains rules and state, line of business and CMS-specific regulations regarding 837I EDI transactions. 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. To avoid rejections please split the services into two separate claim submissions. As of April 1, 2021, WellCare will no longer be a separate plan option offered by South Carolina Healthy Connections Choices. 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. Need an account? Ambetter from Absolute Total Care - South Carolina. 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. Example of how to properly split claim that span the cutover date of April 1, 2021: Q. Examples: If Statement Range is March 14, 2021 through April 3, 2021, please send to WellCare. Q. Wellcare wants to ensure that claims are handled as efficiently as possible. If an authorization is needed, you can log in to the Secure Provider Portal at absolutetotalcare.com to submit and confirm authorizations. Please use the earliest From Date. WellCare of North Carolina partners with providers to develop and deliver high-quality, cost-effective health care solutions. A. Q. It is 30 days to 1 year and more and depends on . Please use WellCare Payor ID 14163. Absolute Total Care WellCare claims will be processed according to timely filing provisions in the providers WellCare Participating Provider Agreement. From Date Institutional Statement Dates prior to 4/1/2021 should be filed to WellCare of South Carolina. Tampa, FL 33631-3384. 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. Ancillary Claims Filing Reminders; ClaimsXten TM: Correct Coding Initiative Reference Guide; Inpatient Non-Reimbursable Charges/Unbundling Policy Q. You may file your second level grievance review within 30 days of receiving your grievance decision letter. 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. Symptoms are flu-like, including: Fever Coughing Can I continue to see my current WellCare members? DOS prior toApril 1, 2021: Processed by WellCare. Professional and Institutional Fee-For-Service EDI transactions should be submitted to WellCare of South Carolina Medicaid with Payer ID 14163. We are simplifying Medicare so you can choose and use an affordable local plan that will help you achieve your best possible health. Pharmacy services prior to April 1, 2021 must be requested from WellCare of South Carolina. 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. 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. The Medicare portion of the agreement will continue to function in its entirety as applicable. The participating provider agreement with WellCare will remain in-place after April 1, 2021. Coronavirus Disease 2019 (COVID-19) causes respiratory illness in people and can spread from person to person. 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 general questions about claims submissions, call Provider Claims Services at 1-800-575-0418. Providers will follow Absolute Total Care Medicaid policies and procedures for all services, inclusive of medical, behavioral, and pharmaceutical benefits, provided to WellCare Medicaid members transitioning to Absolute Total Care for dates of service on or after April 1, 2021. 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.