Please contact our Provider Services Call Center at 1-888-898-7969. Kasapulam ti tulong? The annual flu vaccine helps prevent the flu. Or it can be made if we take too long to make a care decision. 1096 0 obj <>stream Please use the From Date Institutional Statement Date. No, Absolute Total Care will continue to operate under the Absolute Total Care name. To do so by phone, call Member Services at 1-888-588-9842 (TTY1-877-247-6272). Forgot Your Password? Earliest From Dates prior to April 1, 2021 should be filed to WellCare of South Carolina. WellCare offers participating providers EFT and ERA services at no charge through PaySpan Health. Providers are encouraged to visit the Provider Resources webpagefor manuals, forms, and resources related to claims submission, eligibility, prior authorization, and more. Our toll-free fax number is 1-877-297-3112. Claims submission, correspondence, and contact resources will stay the same for the Medicare line of business. Beginning. South Carolina DEPARTMENT OF HEALTH AND HUMAN SERVICES Post Office Box 8206 Columbia, South Carolina 29202-8206 www.scdhhs.gov November 24, 2009 ALL . 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. 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. All dates of service on or after 4/1/2021 should be filed to Absolute Total Care. 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. At the hearing, well explain why we made our decision. 2023 Medicare and PDP Compare Plans and Enroll Now. The provider needs to contact Absolute Total Care to arrange continuing care. Date of Occurrence/DOSprior toApril 1, 2021: Processed by WellCare. Download the free version of Adobe Reader. If you need claim filing assistance, please contact your provider advocate. hbbd``b`$= $ Living Well Quality of Care Medicaid Managed Care Medicaid and CHIP Quality Resource Library Improvement Initiatives Performance Measurement Releases & Announcements Enrollment Strategies Continuous Eligibility Express Lane Eligibility Lawfully Residing Immigrant Children & Pregnant Women Presumptive Eligibility Home & Community Based Services The provider needs to contact Absolute Total Care to arrange continuing care. We understand that maintaining a healthy community starts with providing care to those who need it most. 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. WellCare and Absolute Total Care Medicare plans will continue to operate under current brands, product names and provider contracts, until further notice. We will call you with our decision if we decide you need a fast appeal. We cannot disenroll you from our plan or treat you differently. Timely Filing Beginning October 1, 2020, the Timely Filing submission requirements specified in each Provider's Meridian Medicare contract will be enforced. 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. 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. 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. Q. WellCare claims will be processed according to timely filing provisions in the providers WellCare Participating Provider Agreement. We will give you information to help you get the most from your benefits and the services we provide. 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. Absolute Total Care will honor those authorizations. Q. What is the Rx BIN and Group Number for WellCare members transitioning to Absolute Total Care on April 1, 2021? WellCare has partnered with Change Healthcare as our preferred EDI Clearinghouse. We're here for you. Q. It can also be about a provider and/or a service. Absolute Total Care will continue to offer Marketplace products under the Ambetter brand. As of April 1, 2021 Absolute Total Care, a Centene company, is now the health plan for South Carolina Medicaid members. Claims for services on or after April 1, 2021 should be filed to Absolute Total Care for processing. Examples: If Statement Range is March 14, 2021 through April 3, 2021, please send to WellCare. 0 You may request a State Fair Hearing at this address: South Carolina Department of Health DOS April 1, 2021 and after: Processed by Absolute Total Care. Reminder: It is important that providers check eligibility prior to providing services as members can potentially change plans prior to April 1, 2021 if they are in the annual choice period. A. It will let you know we received your appeal. 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. Claim Filing AmeriHealth Caritas North Carolina, hereafter referred to as the Plan (where appropriate), is required by the North Carolina and federal regulations to capture specific data regarding services rendered to its members. Ambetter from Absolute Total Care - South Carolina. Earliest From Dates prior to 4/1/2021 should be filed to WellCare of South Carolina. Payments mailed to providers are subject to USPS mailing timeframes. Reconsideration or Claim Disputes/Appeals: 8h} \x p`03 1z`@+`~70 G ~Ws5Puick79,4 ,O5@?O-Gr'|5Oj:v6/` 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. WellCare claims will be processed according to timely filing provisions in the providers WellCare Participating Provider Agreement. and Human Services As of April 1, 2021, all WellCare of South Carolina Medicaid members will become Absolute Total Care members. For general questions about claims submissions, call Provider Claims Services at 1-800-575-0418. UHC Community TFL - Timely filing Limit: 120 Days: Unitedhealthcare TFL - Timely filing Limit: Participating Providers: 90 days Non Participating Providers: 180 Days If its secondary payer: 90 days from date of Primary Explanation of Benefits Unitedhealthcare timely filing limit for appeals: 12 months from original claim determination Absolute Total Care will honor all existing WellCare authorization approvals that include dates of service beyond March 31, 2021. We are proud to announce that WellCare is now part of the Centene Family. Learn more about how were supporting members and providers. Yes, Absolute Total Care and WellCare will continue to offer Medicare products under their current brands and product names, until further notice. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. If your services are continued during an appeal or a hearing, you can keep getting them until: If the hearing is decided in your favor, well approve and pay for the care that is needed. South Carolina | Wellcare SOUTH CAROLINA Healthcare done well. 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. endstream endobj startxref Search for primary care providers, hospitals, pharmacies, and more! Please be sure to use the correct line of business prior authorization form for prior authorization requests. Federal Employee Program (FEP) Federal Employee Program P.O. All billing requirements must be adher ed to by the provider in order to ensure timely processing of claims. Q. 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. Additionally, WellCare will have a migration section on their provider page at publishing FAQs. This must be done within 120 days from the date of Notice of Appeal Resolution you received from us. This manual sets forth the policies and procedures that providers participating in the Absolute Total Carenetwork are required tofollow. Q: What is Absolute Total Cares Transition/Continuity of Care Policy? Or you can have someone file it for you. We will send you another letter with our decision within 90 days or sooner. Q. 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 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. WellCare of South Carolina will be known as Absolute Total Care as of April 1, 2021. With the completion of this transaction, we have created a premier healthcare enterprise focused on government-sponsored healthcare programs. Box 8206 We will notify you orally and in writing. Instructions on how to submit a corrected or voided claim. This includes providing assistance with accessing interpreter services and hearing impaired . The Medicare portion of the agreement will continue to function in its entirety as applicable. 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. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. This manual sets forth the policies and procedures that providers participating in the Wellcare Prime network are required tofollow. 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. It was a smart move. Ancillary Claims Filing Reminders; ClaimsXten TM: Correct Coding Initiative Reference Guide; Inpatient Non-Reimbursable Charges/Unbundling Policy You will get a letter from us when any of these actions occur. 2) Reconsideration or Claim disputes/Appeals. 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. S< This gives members time to establish with a new provider in the network and ensure that they have continuity of care. You can ask for a State Fair Hearing after we make our appeal decision. Farmington, MO 63640-3821. An appeal is a request you can make when you do not agree with a decision we made about your care. 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. A. Medicaid Claims Payment Policies Claim Filing Manual - First Choice by Select Health of South Carolina 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. Box 6000 Greenville, SC 29606. Instructions on how to submit a corrected or voided claim. The onlineProvider Manual represents the most up-to-date information on Wellcare Prime by Absolute Total Care (Medicare-Medicaid Plan), programs, policies, and procedures. Claims will be processed according to timely filing provisions in the providers WellCare Participating Provider Agreement. 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 Addakam ditoy para kenka. P.O. We are proud to announce that WellCare is now part of the Centene Family. Wellcare uses cookies. 837 Institutional Encounter 5010v Guide Initial Claims: 120 Days from the Date of Service. We process check runs daily, with the exception of Sundays, National Holidays, and the last day of the month. However, as of April 1, 2021, all WellCare of South Carolina Medicaid members will become Absolute Total Care members. 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. 1,flQ*!WLOmsmz\D;I5BI,yA#z!vYQi5'fedREF40 b666q1(UtUJJ.i` (T/@E 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. P.O. A. Box 600601 Columbia, SC 29260. Send your written appeal to: We must have your written consent before someone can file an appeal for you. A. $8v + Yu @bAD`K@8m.`:DPeV @l A. For current information, visit the Absolute Total Care website. Register now at https://www.payspanhealth.com or contact PaySpan at providersupport@payspanhealth.com, or 877-331-7154. Claims for services prior to April 1, 2021 should be filed to WellCare for processing. * Username. Absolute Total Care Providers interested in joining the Absolute Total Care vision network for routine vision services can contact Envolve Vision at 1-800-531-2818. Members can continue to receive services from their current WellCare provider as long as they remain covered under WellCare. We are simplifying Medicare so you can choose and use an affordable local plan that will help you achieve your best possible health. P.O. You can do this at any time during your appeal. WellCare of North Carolina partners with providers to develop and deliver high-quality, cost-effective health care solutions. Explains rules and state, line of business and CMS-specific regulations regarding 837I EDI transactions. How do I bill a professional submission with services spanning before and after 04/01/2021? Select your topic and plan and click "Chat Now!" to chat with a live agent! If at any time you need help filing one, call us. Explains how to receive, load and send 834 EDI files for member information. Contact Absolute Total Care Provider Service at1-866-433-6041if youhave questions. %%EOF 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. Get an annual flu shot today. You can also have a video visit with a doctor using your phone or computer. Please Explore the Site and Get To Know Us. Check out the Interoperability Page to learn more. You or your authorized representative can review the information we used to make our decision. Providers can help facilitate timely claim payment by having an understanding of our processes and requirements.

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