Wellcare uses cookies. First Choice can accept claim submissions via paper or electronically (EDI). A. WellCare credentialing cycles will be shared with Absolute Total Care in order to reduce duplicative credentialing in the future. Obstetrician care provided by an out-of-network obstetrician will be covered for pregnant members inclusive of postpartum care. It is 30 days to 1 year and more and depends on . 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. You can file a grievance by calling or writing to us. However, there will be no members accessing/assigned to the Medicaid portion of the agreement. Tampa, FL 33631-3372. Professional and Institutional Fee-For-Service EDI transactions should be submitted to WellCare of South Carolina Medicaid with Payer ID 14163. Claims Department Q. A. %PDF-1.6 % Box 31224 What is the Rx BIN and Group Number for WellCare members transitioning to Absolute Total Care on April 1, 2021? Providers interested in joining the Absolute Total Care vision network for routine vision services can contact Envolve Vision at 1-800-531-2818. Providers can help facilitate timely claim payment by having an understanding of our processes and requirements. Timely filing is when you file a claim within a payer-determined time limit. 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. As of April 1, 2021, WellCare will no longer be a separate plan option offered by South Carolina Healthy Connections Choices. You may do this in writing or in person. You can get many of your Coronavirus-related questions answered here. We will give you information to help you get the most from your benefits and the services we provide. You will need Adobe Reader to open PDFs on this site. 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. 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? Here are some guides we created to help you with claims filing. Example of how to properly split claim that span the cutover date of April 1, 2021: Q. S< Always verify timely filing requirements with the third party payor. Contact Us Y0020_WCM_100876E Last Updated On: 10/1/2022 People of all ages can be infected. Finding a doctor is quick and easy. Provider can't require members to appoint them as a condition of getting services. A. Box 3050 Wfu neebybfgnh bgWfulnybfgC South Carolina Medicaid Provider Resource Guide Thank you for being a star member of our provider team. WellCare of South Carolina will be known as Absolute Total Care as of April 1, 2021. Will WellCare continue to offer current products or Medicare only? Q. A. Coronavirus Disease 2019 (COVID-19) causes respiratory illness in people and can spread from person to person. 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. However, there will be no members accessing/assigned to the Medicaid portion of the agreement. Explains rules and state, line of business and CMS-specific regulations regarding 837I EDI transactions. More Information Coronavirus (COVID-19) 8h} \x p`03 1z`@+`~70 G ~Ws5Puick79,4 ,O5@?O-Gr'|5Oj:v6/` Box 8206 Columbia, SC 29202-8206 Or call 1-800-763-9087. We will send you another letter with our decision within 90 days or sooner. Q. 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. An appeal is a request you can make when you do not agree with a decision we made about your care. Members can continue to receive services from their current WellCare provider as long as they remain covered under WellCare. Guides Filing Claims with WellCare. WellCare of North Carolina Medicaid providers are not required to obtain an authorization for professional services for the 90-day post-go live period from July 1, 2021 through September 28, 2021. These SNP plans provide benefits beyond Original Medicare, and may include transportation to medical appointments and vision exams. To write us, send mail to: You can fax it too. 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. DOSApril 1, 2021 and after: Processed by Absolute Total Care. State Health Plan State Claims P.O. 2023 Medicare and PDP Compare Plans and Enroll Now. 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. We expect this process to be seamless for our valued members, and there will be no break in their coverage. Member Appeals (Medical, Behavioral Health, and Pharmacy): Copyright 2023 Wellcare Health Plans, Inc. As of April 1, 2021, all WellCare of South Carolina Medicaid members will become Absolute Total Care members. 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. North Carolina PHP Billing Guidance for Local W Code. WellCare of South Carolina will be known as Absolute Total Care as of April 1, 2021. The rules include what we must do when we get a grievance. Click below for more information from Absolute Total Care: You are now able to view your health information from a third-party app on a mobile device or PC! 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. WellCare claims will be processed according to timely filing provisions in the providers WellCare Participating Provider Agreement. BlueCross BlueShield of South Carolina Piedmont Service Center P.O. 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. 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, Shortened Notification of Pregnancy (NOP) Provider Form (PDF), Notification of Pregnancy (NOP) Provider Form (PDF), Pregnancy Incentive Reimbursement Form (PDF), SCDHHS Form 1716 - Request for Medicaid ID Number - Infant (PDF), Member Appointment of Authorized Representative Form (PDF), SCDHHS Hospice Election/Enrollment Forms (PDF), Inpatient Prior Authorization Fax Form (PDF), Outpatient Prior Authorization Fax Form (PDF), SCDHHS Certificate of Medical Necessity (CMN) for Oxygen (PDF), Sick and Well Visit Reimbursement Letter (PDF), Claim Adjustments, Reconsiderations, and Disputes Provider Education (PDF), Obstetrical (OB) Incentive Programs (PDF), Provider Portal Enhancements: Claim Reconsideration and Denial Explanations (PDF), Outpatient Prior Authorization Form (PDF), Medicare Prescription Drug Coverage Determination Form (PDF), Authorization to Use and/or Disclose Health Information (PDF), Revocation of Authorization to Use and/or Disclose Health Information (PDF), Behavioral Health Psychological or Neuropsychological Testing Authorization Request Form (PDF), Electroconvulsive Therapy (ECT) Authorization Request Form (PDF), Behavioral Health Outpatient Treatment Request Form (PDF), Transitional Care Management Services Fact Sheet (PDF), Expedited Prior Authorization Request FAQ (PDF), Balance Billing Quick Reference Guide (PDF), 2021 Prior Authorization List Part B Appendix A (PDF), Bi-Annual Prior Authorization Update (PDF), 2021 Bi-Annual Prior Authorization Update Effective 8/1/21 (PDF), 2021 List of Covered Drugs (Formulary) Changes (PDF), New Century Health Implementation Notification (PDF), 2022 Wellcare by Allwell Provider Manual (PDF), Provider Reconsideration/Dispute Form (PDF), Behavioral Health Neuropsychological Testing Authorization Request Form (PDF), Behavioral Health Outpatient Treatement Request Form (PDF), Behavioral Health Electroconvulsive Therapy (ECT) Authorization Request Form (PDF), Electronic Funds Transfer (ETF) Features (PDF), 2021 List of Covered Drugs (Formulary) DSNP Changes (PDF), 2021 List of Covered Drugs (Formulary) HMO Changes (PDF). This manual sets forth the policies and procedures that providers participating in the Wellcare Prime network are required tofollow. Ambetter from Absolute Total Care - South Carolina. The timely filing limit is the time duration from service rendered to patients and submitting claims to the insurance companies. Absolute Total Care will utilize credentialing cycles from WellCare and Absolute Total Care so that providers will only need to credential once every three years. Our call centers, including the nurse advice line, are currently experiencing high volume. Earliest From Dates on or after 4/1/2021 should be filed to Absolute Total Care. April 1-April 3, 2021, please send to Absolute Total Care. WellCare has partnered with Change Healthcare as our preferred EDI Clearinghouse. Claims will be processed according to timely filing provisions in the providers Absolute Total Care Participating Provider Agreement. 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 Addakam ditoy para kenka. Pregnant members receiving care from an out of network Obstetrician can continue to see their current Obstetrician until after the baby is born. They must inform their vendor of AmeriHealth Caritas . Will Absolute Total Care change its name to WellCare? If an authorization is needed, you can log in to the Secure Provider Portal at absolutetotalcare.com to submit and confirm authorizations. Welcome to WellCare of South Carolina! 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. A grievance is when you tell us about a concern you have with our plan. Utilize interactive health and wellness tools to help you manage conditions, improve your health and save money. To do this: Be sure to ask us to continue your benefits within the 10 calendar day time frame. Q. 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. Absolute Total Care will honor those authorizations. The annual flu vaccine helps prevent the flu. 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. A. 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. We are committed to improving the quality of life of our millions of members, who often include some of our nations most vulnerable populations. 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. Box 6000 Greenville, SC 29606. N .7$* P!70 *I;Rox3 ] LS~. A. If you dont, we will have to deny your request. L]4(f4/pn~YTZSp-5/O*F)e~p:a6o{x8r The Claim Reconsideration process is an informal claim review, and is not a substitute for an appeal of a final agency decision.