They must inform their vendor of AmeriHealth Caritas . 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. If you need claim filing assistance, please contact your provider advocate. April 1-April 3, 2021, please send to Absolute Total Care. As a member you may request a 14 day extension of your grievance, you may do so by calling Member Services at 1-888-588-9842 (TTY 1-877-247-6272) or You may send your request for extension in writing to: WellCare Health Plans A. Our call centers, including the nurse advice line, are currently experiencing high volume. 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. Stay informed - activate your online account Behavioral Health Crisis Line 844-594-5076 (TTY 711) 24 hours a day, seven days a week Call us if you are experiencing emotional or mental pain or distress. Please use the Earliest From Date. 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 of South Carolina will be known as Absolute Total Care as of April 1, 2021. 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? You can get many of your Coronavirus-related questions answered here. Q. We must have your written permission before someone can file a grievance for you. Section 1: General Information. Members can continue to receive services from their current WellCare provider as long as they remain covered under WellCare. Q. If you ask for a fast appeal and we decide that one is not needed, we will: You or your authorized representative can give us more information if you think itll help your appeal (regular or fast). Q. BlueCross BlueShield of South Carolina Piedmont Service Center P.O. Box 6000 Greenville, SC 29606. P.O. Earliest From Dates on or after April 1, 2021 should be filed to Absolute Total Care. The member will be encouraged to establish care with a new in network PCP/specialist prior to the end of the transition/continuity of care period to review present treatment plan and coordinate the member's medical care. We expect this process to be seamless for our valued members, and there will be no break in their coverage. From Date Institutional Statement Dates on or after 4/1/2021 should be filed to Absolute Total Care. A. You may do this in writing or in person. The Medicare portion of the agreement will continue to function in its entirety as applicable. %%EOF hb```b``6``e`~ "@1V NB, Instructions on how to submit a corrected or voided claim. DOS prior toApril 1, 2021: Processed by WellCare. Timely filing limits vary. For current information, visit the Absolute Total Care website. Member Appeals (Medical, Behavioral Health, and Pharmacy): You will need Adobe Reader to open PDFs on this site. Download the free version of Adobe Reader. WellCare Medicare Advantage Claims must be filed within 180 calendar days from the date of service. All Paper Claim Submissions can be mailed to: WellCare Health Plans This manual sets forth the policies and procedures that providers participating in the Wellcare Prime network are required to follow. This person has all beneficiary rights and responsibilities during the appeal process. Providers are encouraged to visit the Provider Resources webpagefor manuals, forms, and resources related to claims submission, eligibility, prior authorization, and more. You will have a limited time to submit additional information for a fast appeal. Send your written appeal to: We must have your written consent before someone can file an appeal for you. If you need assistance with your appeal please call Absolute Total Care at 1-866-433-6041 (TTY: 711) and we will assist you in filing your appeal. Reimbursement Policies P.O. We cannot disenroll you from our plan or treat you differently. 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? These SNP plans provide benefits beyond Original Medicare, and may include transportation to medical appointments and vision exams. WellCare has partnered with Change Healthcare as our preferred EDI Clearinghouse. A. Thanka kaa yoa Tufrbeau ingsnh ngetfu South Caralaita nouMa mpvd. Always verify timely filing requirements with the third party payor. 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. P.O. pst/!+ Y^Ynwb7tw,eI^ 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. People of all ages can be infected. 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. At the hearing, well explain why we made our decision. Box 8206 Columbia, SC 29202-8206 Or call 1-800-763-9087. 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. Here are some guides we created to help you with claims filing. 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. That's why we provide tools and resources to help. 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. Claims will be processed according to timely filing provisions in the providers WellCare Participating Provider Agreement. Box 8206 WellCare and Absolute Total Care Medicare plans will continue to operate under current brands, product names and provider contracts, until further notice. It is called a "Notice of Adverse Benefit Determination" or "NABD." All dates of service prior to April 1, 2021 should be filed to WellCare of South Carolina. 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. 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. For standard requests, if you call in your appeal, you must follow up with a written, signed one, within thirty calendar days. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. Members will need to talk to their provider right away if they want to keep seeing him/her. Effective January 1, 2015 the South Carolina Department of Health and Human Services (SCDHHS) will implement a Claim Reconsideration Policy. #~0 I B^E{h#XYQv;[ny3Hha1yx4v.sBy jWacQzyL.kHhwtQ~35!Rh#)p+sj31LcC)4*Z:IWIG@WTD- )n,! 3) Coordination of Benefits. We will give you information to help you get the most from your benefits and the services we provide. Download the free version of Adobe Reader. Paper Claim Submission Submit paper claims to: WellCare Health Plans Electronic Claim Submission To initiate electronic claims, both in-network and out-of-network providers should contact their practice management software vendor or EDI software vendor. Q. 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. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. 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. A. WellCare of South Carolina will be known as Absolute Total Care as of April 1, 2021. 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. If you dont, we will have to deny your request. 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. 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. Outpatient Prior Authorization Form (PDF) Inpatient Prior Authorization Form (PDF) P.O. If an authorization is needed, you can log in to the Secure Provider Portal at absolutetotalcare.com to submit and confirm authorizations. 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 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 . This manual sets forth the policies and procedures that providers participating in the Absolute Total Carenetwork are required tofollow. Payments mailed to providers are subject to USPS mailing timeframes. A. No, Absolute Total Care will continue to operate under the Absolute Total Care name. Providers are encouraged to sign up to receive EFT payments to avoid any payment delays. A. 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. For dates of service on or after April 1, 2021: Absolute Total Care Visit https://msp.scdhhs.gov/appeals/ to: Copyright 2023 Wellcare Health Plans, Inc. https://msp.scdhhs.gov/appeals/site-page/file-appeal, If we deny or limit a service you or your doctor asks us to approve, If we reduce, suspend or stop services youve been getting that we already approved, If we do not pay for the health care services you get, If we fail to give services in the required timeframe, If we fail to give you a decision in the required timeframe on an appeal you already filed, If we dont agree to let you see a doctor who is not in our network and you live in a rural area or in an area with limited doctors, If you dont agree with a decision we made regarding your medicine, We denied your request to dispute a financial liability, The member did not personally receive the notice of action or received the notice late, The member was seriously ill, which prevented a timely appeal, There was a death or serious illness in the members immediate family, An accident caused important records to be destroyed, Documentation was difficult to locate within the time limits; and/or the member had incorrect or incomplete information concerning the appeals process, Change the appeal to the timeframe for a standard decision (30 calendar days), Follow up with a written letter within 2 calendar days, Tell you over the phone and in writing that you may file a grievance about the denial of the fast appeal request, Be in writing and specify the reason for the request, Include your name, address and phone number, Indicate the date of service or the type of service denied, Your authorized representative (if youve chosen one), A hearing officer from Medicaid and Long-Term Care (MLTC), You or your authorized representative with your written consent must file your appeal with us and ask to continue your benefits within 10 calendar days after we mail the Notice of Adverse benefit determination; or, Within 10 calendar days of the intended effective date of the plans proposed action, whichever is later, The appeal or hearing must address the reduction, suspension or stopping of a previously authorized service, The services were ordered by an authorized provider, The period covered by the original authorization cannot have ended. We are glad you joined our family! 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. Where should I submit claims for WellCare Medicaid members that transition to Absolute Total Care? 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 Please contact our Provider Services Call Center at 1-888-898-7969. Tampa, FL 33631-3372. North Carolina PHP Billing Guidance for Local W Code. Awagandakami Members must have Medicaid to enroll. The Claim Reconsideration process is an informal claim review, and is not a substitute for an appeal of a final agency decision. 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. 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. We have licensed clinicians available to speak with you and to connect you to the support you need to feel better. Wellcare uses cookies. Search for primary care providers, hospitals, pharmacies, and more! Obstetrician care provided by an out-of-network obstetrician will be covered for pregnant members inclusive of postpartum care. Wellcare uses cookies. However, as of April 1, 2021, all WellCare of South Carolina Medicaid members will become Absolute Total Care members. Will WellCare continue to offer current products or Medicare only? You will need Adobe Reader to open PDFs on this site. Obstetrician care provided by an out of network Obstetrician will be covered for pregnant members inclusive of post-partum care. Q. Providers interested in joining the Absolute Total Care vision network for routine vision services can contact Envolve Vision at 1-800-531-2818. A hearing officer from the State will decide if we made the right decision. 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.