Members who are dealing with stress or anxiety can call our 24-Hour Behavioral Health Crisis Line at 1-833-207-4240 to speak with a trained professional. 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). Box 8206 As of April 1, 2021, WellCare will no longer be a separate plan option offered by South Carolina Healthy Connections Choices. DOS April 1, 2021 and after: Processed by Absolute Total Care. Claim Filing Manual - First Choice by Select Health of South Carolina Box 31384 Providers can help facilitate timely claim payment by having an understanding of our processes and requirements. 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. 8h} \x p`03 1z`@+`~70 G ~Ws5Puick79,4 ,O5@?O-Gr'|5Oj:v6/` You or your provider must call or fax us to ask for a fast appeal. Our health insurance programs are committed to transforming the health of the community one individual at a time. the timely filing limits due to the provider being unaware of a beneficiary's coverage. Wellcare uses cookies. Claims will be processed according to timely filing provisions in the providers WellCare Participating Provider Agreement. The timely filing limit is the time duration from service rendered to patients and submitting claims to the insurance companies. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. Kasapulam ti tulong? 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. Download the free version of Adobe Reader. We are simplifying Medicare so you can choose and use an affordable local plan that will help you achieve your best possible health. A. WellCare credentialing cycles will be shared with Absolute Total Care in order to reduce duplicative credentialing in the future. We will also send you a letter with our decision within 72 hours from receiving your appeal. State Health Plan State Claims P.O. A. Tampa, FL 33631-3372. You or your authorized representative will tell the hearing officer why you think we made the wrong decision. WellCare credentialing cycles will be shared with Absolute Total Care in order to reduce duplicative credentialing in the future. A. BlueCross BlueShield of South Carolina Piedmont Service Center P.O. N .7$* P!70 *I;Rox3 ] LS~. Professional and Institutional Fee-For-Service EDI transactions should be submitted to WellCare of South Carolina Medicaid with Payer ID 14163. We must have your written permission before someone can file a grievance for you. Claims will be processed according to timely filing provisions in the providers Absolute Total Care Participating Provider Agreement. The annual flu vaccine helps prevent the flu. Explains rules and state, line of business and CMS-specific regulations regarding 837I EDI transactions. Providers interested in joining the Absolute Total Care vision network for routine vision services can contact Envolve Vision at 1-800-531-2818. It can also be about a provider and/or a service. An authorized representative is someone you select to act on the behalf of a member to assist them through the appeals process. Want to receive your payments faster to improve cash flow? 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. Absolute Total Care will honor all existing WellCare authorization approvals that include dates of service beyond March 31, 2021. Explains rules and state, line of business and CMS-specific regulations regarding 837P EDI transactions. As of April 1, 2021, all WellCare of South Carolina Medicaid members will become Absolute Total Care members. South Carolina DEPARTMENT OF HEALTH AND HUMAN SERVICES Post Office Box 8206 Columbia, South Carolina 29202-8206 www.scdhhs.gov November 24, 2009 ALL . Resources 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. 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. A. The rules include what we must do when we get a grievance. This gives members time to establish with a new provider in the network and ensure that they have continuity of 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. 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. Box 3050 It is called a "Notice of Adverse Benefit Determination" or "NABD." hb```b``6``e`~ "@1V NB, 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. We will send you another letter with our decision within 90 days or sooner. Beginning. 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. Q. Providers are encouraged to sign up to receive EFT payments to avoid any payment delays. 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. We want you to let us know right away if you have any questions, grievances or problems with your covered services or the care you receive. Reimbursement Policies 1096 0 obj <>stream That's why we provide tools and resources to help. Providers can help facilitate timely claim payment by having an understanding of our processes and requirements. The provider needs to contact Absolute Total Care to arrange continuing care. Hearings are used when you were denied a service or only part of the service was approved. Q. We welcome Brokers who share our commitment to compliance and member satisfaction. Providers interested in joining the Absolute Total Care vision network for routine vision services can contact Envolve Vision at 1-800-531-2818. 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. endstream endobj 1045 0 obj <>/Metadata 50 0 R/OpenAction 1046 0 R/Outlines 160 0 R/Pages 1042 0 R/StructTreeRoot 166 0 R/Type/Catalog/ViewerPreferences<>>> endobj 1046 0 obj <> endobj 1047 0 obj <>/Font<>/ProcSet[/PDF/Text/ImageC/ImageB/ImageI]/XObject<>>>/Rotate 0/StructParents 0/Tabs/S/TrimBox[0.0 0.0 612.0 792.0]/Type/Page>> endobj 1048 0 obj <>stream 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. P.O. %PDF-1.6 % A. WellCare of South Carolina will be known as Absolute Total Care as of April 1, 2021. The Medicare portion of the agreement will continue to function in its entirety as applicable. WellCare of South Carolina will be known as Absolute Total Care as of April 1, 2021. Absolute Total Care will honor those authorizations. As of April 1, 2021, all WellCare of South Carolina Medicaid members will transfer 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. You, your friend, a relative, legal counsel or other spokesperson who has your written consent may ask for a State Fair Hearing. How will credentialing/recredentialing be handled by Absolute Total Care if a provider was recently credentialed/recredentialed by WellCare? WellCare offers participating providers EFT and ERA services at no charge through PaySpan Health. You may file your second level grievance review within 30 days of receiving your grievance decision letter. With the completion of this transaction, we have created a premier healthcare enterprise focused on government-sponsored healthcare programs. 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. P.O. WellCare of South Carolinawants to ensure that claims are handled as efficiently as possible. 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 The Medicare portion of the agreement will continue to function in its entirety as applicable. Q. Thanka kaa yoa Tufrbeau ingsnh ngetfu South Caralaita nouMa mpvd. Earliest From Dates on or after April 1, 2021 should be filed to Absolute Total Care. Symptoms are flu-like, including: Fever Coughing Select your topic and plan and click "Chat Now!" to chat with a live agent! Claims for services prior to April 1, 2021 should be filed to WellCare for processing. All dates of service on or after April 1, 2021 should be filed to Absolute Total Care. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. A grievance is when you tell us about a concern you have with our plan. Example of how to properly split claim that span the cutover date of 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. Absolute Total Care will honor all existing WellCare authorization approvals that include dates of service beyond March 31, 2021. 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. Q. Our fax number is 1-866-201-0657. Providers interested in joining the Absolute Total Care Provider Network should submit a request to Network Development and Contracting via email at. The participating provider agreement with WellCare will remain in-place after April 1, 2021. 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. Farmington, MO 63640-3821. Ancillary Claims Filing Reminders; ClaimsXten TM: Correct Coding Initiative Reference Guide; Inpatient Non-Reimbursable Charges/Unbundling Policy Here you will find the tools and resources you need to help manage your submission of claims and receipt of payments. Instructions on how to submit a corrected or voided claim. In South Carolina, WellCare and Absolute Total Care are joining to better serve you. Coronavirus Disease 2019 (COVID-19) causes respiratory illness in people and can spread from person to person. 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. Can I continue to see my current WellCare members? Providers can help facilitate timely claim payment by having an understanding of our processes and requirements. To avoid rejections please split the services into two separate claim submissions. Effective January 1, 2015 the South Carolina Department of Health and Human Services (SCDHHS) will implement a Claim Reconsideration Policy. All dates of service prior to 4/1/2021 should be filed to WellCare of South Carolina. A provider can act for a member in hearings with the member's written permission in advance. Box 100605 Columbia, SC 29260. You and the person you choose to represent you must sign the AOR form. To have someone represent you, you must complete an Appointment of Representative (AOR) form. You will receive an acknowledgement letter within 5 business days, and we will send you a resolution within 90 calendar days. This must be done within 120 days from the date of Notice of Appeal Resolution you received from us. WellCare and Absolute Total Care Medicare plans will continue to operate under current brands, product names and provider contracts, until further notice. Obstetrician care provided by an out of network Obstetrician will be covered for pregnant members inclusive of post-partum care. In this section, we will explain how you can tell us about these concerns/grievances. Get an annual flu shot today. 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. We will do this as quickly as possible as but no longer than 72-hours from the decision. Box 6000 Greenville, SC 29606. Or you can have someone file it for you. We will call you with our decision if we decide you need a fast appeal. If you are unable to view PDFs, please download Adobe Reader. We expect this process to be seamless for our valued members and there will be no break in their coverage. Earliest From Dates prior to 4/1/2021 should be filed to WellCare of South Carolina. Pharmacy services prior to 4/1/2021 must be requested from WellCare South Carolina. Wellcare uses cookies. Please use the From Date Institutional Statement Date. As of April 1, 2021 Absolute Total Care, a Centene company, is now the health plan for South Carolina Medicaid members. It will tell you we received your grievance. and Human Services P.O. South Carolina Department of Health and Human Services Division of Appeals and Hearings P.O. The hearing officer will decide whether our decision was right or wrong. WellCare and Absolute Total Care Medicare plans will continue to operate under current brands, product names and provider contracts, until further notice. 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. 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 annual flu vaccine helps prevent the flu.Protect yourself and those around you. For additional information, questions or concerns, please contact your local Provider Network Management Representative. 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. Within five business days of getting your grievance, we will mail you a letter. WellCare of North Carolina will begin to release medical payments to providers beginning July 6, 2021. Learn more about how were supporting members and providers. 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). We cannot disenroll you from our plan or treat you differently. We want to ensure that claims are handled as efficiently as possible. We will continue covering your medical services during your appeal request and State Fair Hearing if all of the following are meet. (This includes your PCP or another provider.) Q. Initial Claims: 120 Days from the Date of Service. Outpatient Prior Authorization Form (PDF) Inpatient Prior Authorization Form (PDF) 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. There is a lot of insurance that follows different time frames for claim submission. Members will receive a 90-day transition of care period if the member is receiving ongoing care and treatment. These SNP plans provide benefits beyond Original Medicare, and may include transportation to medical appointments and vision exams. This manual sets forth the policies and procedures that providers participating in the Wellcare Prime network are required tofollow. 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. Only you or your authorizedrepresentative can ask for a State Fair Hearing. UnitedHealthcare Dual Complete Special Needs Plan UnitedHealthcare Dual Complete Special Needs Plans (SNP) offer benefits for people with both Medicare and Medicaid. Absolute Total Care will utilize credentialing cycles from WellCare and Absolute Total Care so that providers will only need to recredential once every three years. We understand that maintaining a healthy community starts with providing care to those who need it most. Those who attend the hearing include: You can also request to have your hearing over the phone. 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. 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. Addakam ditoy para kenka. We would like to help your billing department get your EDI (claims and real time) transactions processed as efficiently as possible. The provider needs to contact Absolute Total Care to arrange continuing 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. Electronic and Paper Claims Submissions; Institutional Claims/Encounter Guides. Q. For dates of service prior to April 1, 2021: All paper claim submissions can be mailed to: WellCare Health Plans Wellcare uses cookies. Examples: If Statement Range is March 14, 2021 through April 3, 2021, please send to WellCare. A. 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. 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. Professional and Institutional Fee-For-Service EDI transactions should be submitted to WellCare of South Carolina Medicaid with Payer ID 14163. WellCare of South Carolina will be known as Absolute Total Care as of April 1, 2021. Claims will be processed according to timely filing provisions in the providers WellCare Participating Provider Agreement. A. From Date Institutional Statement Dates prior to 4/1/2021 should be filed to WellCare of South Carolina. A. Obstetrician care provided by an out-of-network obstetrician will be covered for pregnant members inclusive of postpartum care. Reconsideration or Claim Disputes/Appeals: WellCare of South Carolina will be known as Absolute Total Care as of April 1, 2021. When you receive your notification of WellCares grievance resolution, and you are dissatisfied with the resolution regarding adverse decisions that affect your ability to receive benefits, access to care, access to services or payment for care of services, you may request a second level review with WellCare. To do so by phone, call Member Services at 1-888-588-9842 (TTY1-877-247-6272). Date of Occurrence/DOSprior toApril 1, 2021: Processed by WellCare. However, there will be no members accessing/assigned to the Medicaid portion of the agreement. An appeal may be filed within 60 calendar days from the date on the Adverse Benefit Determination Notice. Incorrect forms will not be considered and may lead to further delays in processing prior authorization requests. They are called: State law allows you to make a grievance if you have any problems with us. However, there will be no members accessing/assigned to the Medicaid portion of the agreement. If you think you might have been exposed, contact a doctor immediately. 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. Register now at https://www.payspanhealth.comor contact PaySpan at providersupport@payspanhealth.com, or 877-331-7154. Provider can't require members to appoint them as a condition of getting services. 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. Farmington, MO 63640-3821. Q. This includes providing assistance with accessing interpreter services and hearing impaired . They must inform their vendor of AmeriHealth Caritas . 1071 0 obj <>/Filter/FlateDecode/ID[<87133B316ADA4BDD8B85BA48A489D34F>]/Index[1044 53]/Info 1043 0 R/Length 117/Prev 692690/Root 1045 0 R/Size 1097/Type/XRef/W[1 2 1]>>stream Members must have Medicaid to enroll. 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. From Date Institutional Statement Dates prior to April 1, 2021 should be filed to WellCare of South Carolina. If Statement Range is April 2, 2021 through April 10, 2021, please send to Absolute Total Care. A. 2) Reconsideration or Claim disputes/Appeals. 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. Forgot Your Password? 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.

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