Providers interested in joining the Absolute Total Care Provider Network should submit a request to Network Development and Contracting via email at. Yes, Absolute Total Care and WellCare will continue to offer Medicare products under their current brands and product names, until further notice. Q. Will WellCare continue to offer current products or Medicare only? Members will receive a 90-day transition of care period if the member is receiving ongoing care and treatment. 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. WellCare of South Carolina will be known as Absolute Total Care as of April 1, 2021. 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. Absolute Total Care will continue to offer Marketplace products under the Ambetter brand. You, your friend, a relative, legal counsel or other spokesperson who has your written consent may ask for a State Fair Hearing. 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. 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. 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. Absolute Total Care will honor those authorizations. 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. Welcome to WellCare Provider Login Contact Us Join Our Network Medicaid Medicare Tools News and Education AcariaHealth Specialty Pharmacy Pharmacy Forms Request for Drug Coverage Request to Review Drug Coverage Denial . By continuing to use our site, you agree to our Privacy Policy and Terms of Use. Guides Filing Claims with WellCare. How are WellCare Medicaid member authorizations being handled after April 1, 2021? Please use the From Date Institutional Statement Date. WellCare has partnered with Change Healthcare as our preferred EDI Clearinghouse. 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. WellCare of South Carolina will be known as Absolute Total Care as of April 1, 2021. To ask for hearing, call 1-800-763-9087 or write to: You also can make a request online using SCDHHS form at https://msp.scdhhs.gov/appeals/site-page/file-appeal. 1,flQ*!WLOmsmz\D;I5BI,yA#z!vYQi5'fedREF40 b666q1(UtUJJ.i` (T/@E Refer to your particular provider type program chapter for clarification. \{-w{,xI202100$0*bZf ,X AayhP3pYla" e 3G& `eoT#@ *;d Claims for services on or after April 1, 2021 should be filed to Absolute Total Care for processing. %PDF-1.6 % 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. APPEALS, GRIEVANCES AND PROVIDER DISPUTES. 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. In this section, we will explain how you can tell us about these concerns/grievances. Download the free version of Adobe Reader. This manual sets forth the policies and procedures that providers participating in the Wellcare Prime network are required to follow. S< From Date Institutional Statement Dates prior to April 1, 2021 should be filed to WellCare of South Carolina. Ambetter Timely Filing Limit of : 1) Initial Claims. Kasapulam ti tulong? Download the free version of Adobe Reader. Timely Filing Limits - Health Network Solutions Get an annual flu shot today. Explains rules and state, line of business and CMS-specific regulations regarding 837P EDI transactions. 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. Please Explore the Site and Get To Know Us. Q. PROVIDERS NOTE:Please send Corrected Claims as normal submissions via electronic or paper. Absolute Total Care will honor those authorizations. Providers are encouraged to visit the Provider Resources webpagefor manuals, forms, and resources related to claims submission, eligibility, prior authorization, and more. For the latest COVID-19 news, visit the CDC. Appeals and Grievances | Wellcare Providers interested in joining the Absolute Total Care vision network for routine vision services can contact Envolve Vision at 1-800-531-2818. Molina Healthcare of Michigan, 100 W. Big Beaver Road, Suite 600 Attn: Claims, Troy, MI 48084-5209 Or Fax to: (248) 925-1768. Coronavirus Disease 2019 (COVID-19) causes respiratory illness in people and can spread from person to person. Claims and billing - Select Health of SC pst/!+ Y^Ynwb7tw,eI^ If you wish to use a representative, then he or she must complete an Appointment of Representative (AOR) statement. 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 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? 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. They are called: State law allows you to make a grievance if you have any problems with us. We expect this process to be seamless for our valued members, and there will be no break in their coverage. Want to receive your payments faster to improve cash flow? You can file an appeal if you do not agree with our decision. With quality healthcare solutions, Ambetter from Absolute Total Care helps residents of South Carolina live better. You will have a limited time to submit additional information for a fast appeal. 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 March 15, 2021. A. It can also be about a provider and/or a service. WellCare claims will be processed according to timely filing provisions in the providers WellCare Participating Provider Agreement. We try to make filing claims with us as easy as possible. A provider can act for a member in hearings with the member's written permission in advance. Resources 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! Copyright 2023 Wellcare Health Plans, Inc. Clinical Laboratory Improvement Amendments (CLIA). Ambetter Timely Filing Limit - Initial Claims, Reconsideration, Appeal You or your authorized representative can review the information we used to make our decision. We are simplifying Medicare so you can choose and use an affordable local plan that will help you achieve your best possible health. A. Q. Explains rules and state, line of business and CMS-specific regulations regarding 837P EDI transactions. We understand that maintaining a healthy community starts with providing care to those who need it most. * Username. 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. A. DOS prior toApril 1, 2021: Processed by WellCare. 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. Providers FAQs | Wellcare Box 31224 BlueCross BlueShield of South Carolina Piedmont Service Center P.O. More Information Coronavirus (COVID-19) Q: What is Absolute Total Cares Transition/Continuity of Care Policy? This must be done within 120 days from the date of Notice of Appeal Resolution you received from us. As of April 1, 2021, WellCare will no longer be a separate plan option offered by South Carolina Healthy Connections Choices. Explains rules and state, line of business and CMS-specific regulations regarding 837I EDI transactions. 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. 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. Copyright 2023 Wellcare Health Plans, Inc. This includes providing assistance with accessing interpreter services and hearing impaired . 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 April 1, 2021. 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. Payments mailed to providers are subject to USPS mailing timeframes. Explains how to receive, load and send 834 EDI files for member information. This manual sets forth the policies and procedures that providers participating in the Absolute Total Carenetwork are required tofollow. 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. A. Wellcare uses cookies. A. Our toll-free fax number is 1-877-297-3112. WellCare of South Carolina will be known as Absolute Total Care as of April 1, 2021. 3) Coordination of Benefits. Please use the Earliest From Date. We are glad you joined our family! We may apply a 14 day extension to your grievance resolution. 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. Wellcare uses cookies. 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. You can get many of your Coronavirus-related questions answered here. A. Members can continue to receive services from their current WellCare provider as long as they remain covered under WellCare. 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. No, Absolute Total Care will continue to operate under the Absolute Total Care name. 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. #~0 I The participating provider agreement with WellCare will remain in-place after April 1, 2021. State Health Plan State Claims P.O. Absolute Total Care will honor all existing WellCare authorization approvals that include dates of service beyond March 31, 2021. Claims will be processed according to timely filing provisions in the providers Absolute Total Care Participating Provider Agreement. Medicaid - Wellcare NC South Carolina : Login (This includes your PCP or another provider.) Wellcare uses cookies. 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. Learn how you can help keep yourself and others healthy. Beginning. Learn more about how were supporting members and providers. If you need claim filing assistance, please contact your provider advocate. It is called a "Notice of Adverse Benefit Determination" or "NABD." WellCare is the health care plan that puts you in control. 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. What is Molina Healthcare timely filing limit? - Short-Question We welcome Brokers who share our commitment to compliance and member satisfaction. WellCare of North Carolina partners with providers to develop and deliver high-quality, cost-effective health care solutions. Register now. Q. 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. With the completion of this transaction, we have created a premier healthcare enterprise focused on government-sponsored healthcare programs. It is 30 days to 1 year and more and depends on . It will let you know we received your appeal. If Statement Range is April 2, 2021 through April 10, 2021, please send to Absolute Total Care. the timely filing limits due to the provider being unaware of a beneficiary's coverage.