How are WellCare Medicaid member authorizations being handled after April 1, 2021? These materials are for informational purposes only. 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. Within five business days of getting your grievance, we will mail you a letter. Earliest From Dates on or after 4/1/2021 should be filed to Absolute Total Care. You can ask for a State Fair Hearing after we make our appeal decision. P.O. 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. WellCare claims will be processed according to timely filing provisions in the providers WellCare Participating Provider Agreement. the timely filing limits due to the provider being unaware of a beneficiary's coverage. WellCare and Absolute Total Care Medicare plans will continue to operate under current brands, product names and provider contracts, until further notice. Explains how to receive, load and send 834 EDI files for member information. Forms. To continue care with their current provider after the 90-day Transition of Care, the provider must agree to work with Absolute Total Care on the member's care and accept Absolute Total Care's payment rates. For dates of service on or after April 1, 2021: Absolute Total Care 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. 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. Wellcare uses cookies. For the death or injury of a member of the South Carolina National Guard, as provided for in Section 42-7-67, the time for filing a claim is two years after the accident or one year after the federal claim is finalized, whichever is later. Go365 for Humana Healthy Horizons Members can register for the new Go365 for Humana Healthy Horizons wellness program and earn rewards for participating in healthy activities. WellCare of South Carolina will be known as Absolute Total Care as of April 1, 2021. Reconsideration or Claim Disputes/Appeals: Section 1: General Information. Member Appeals (Medical, Behavioral Health, and Pharmacy): You will need Adobe Reader to open PDFs on this site. Providers are encouraged to visit the Provider Resources webpagefor manuals, forms, and resources related to claims submission, eligibility, prior authorization, and more. If you wish to use a representative, then he or she must complete an Appointment of Representative (AOR) statement. Pregnant members receiving care from an out of network Obstetrician can continue to see their current Obstetrician until after the baby is born. Members can continue to receive services from their current WellCare provider as long as they remain covered under WellCare. Absolute Total Care will honor those authorizations. Explains rules and state, line of business and CMS-specific regulations regarding 837P EDI transactions. From Date Institutional Statement Dates prior to 4/1/2021 should be filed to WellCare of South Carolina. You now have access to a secure, quick way to electronically settle claims. * Password. Wfu neebybfgnh bgWfulnybfgC South Carolina Medicaid Provider Resource Guide Thank you for being a star member of our provider team. We are simplifying Medicare so you can choose and use an affordable local plan that will help you achieve your best possible health. Reimbursement Policies As of April 1, 2021, WellCare will no longer be a separate plan option offered by South Carolina Healthy Connections Choices. 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. DOS prior to April 1, 2021: Processed by WellCare. As of April 1, 2021 Absolute Total Care, a Centene company, is now the health plan for South Carolina Medicaid members. and Human Services The Claim Reconsideration process is an informal claim review, and is not a substitute for an appeal of a final agency decision. Q. hb```b``6``e`~ "@1V NB, Thanka kaa yoa Tufrbeau ingsnh ngetfu South Caralaita nouMa mpvd. It can also be about a provider and/or a service. You can file a grievance by calling or writing to us. The participating provider agreement with WellCare will remain in-place after 4/1/2021. 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. Check out the Interoperability Page to learn more. We will continue covering your medical services during your appeal request and State Fair Hearing if all of the following are meet. Pregnant members receiving care from an out-of-network Obstetrician can continue to see their current obstetrician until after the baby is born. 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. Providers interested in joining the Absolute Total Care Provider Network should submit a request to Network Development and Contracting via email at. 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? If you think you might have been exposed, contact a doctor immediately. No, Absolute Total Care will continue to operate under the Absolute Total Care name. These SNP plans provide benefits beyond Original Medicare, and may include transportation to medical appointments and vision exams. What is the Rx BIN and Group Number for WellCare members transitioning to Absolute Total Care on April 1, 2021? A. Our fax number is 1-866-201-0657. P.O. WellCare has partnered with Change Healthcare as our preferred EDI Clearinghouse. This manual sets forth the policies and procedures that providers participating in the Absolute Total Carenetwork are required tofollow. Pharmacy services prior to April 1, 2021 must be requested from WellCare of South Carolina. Medicaid Claims Payment Policies It will let you know we received your appeal. Providers can help facilitate timely claim payment by having an understanding of our processes and requirements. If you request a hearing, the request must: A State Fair Hearing is a legal proceeding. P.O. Or it can be made if we take too long to make a care decision. You and the person you choose to represent you must sign the AOR statement. 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. PROVIDERS NOTE:Please send Corrected Claims as normal submissions via electronic or paper. Q. You or your authorized representative can review the information we used to make our decision. Guides Filing Claims with WellCare. In South Carolina, WellCare and Absolute Total Care are joining to better serve you. 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. WellCare of South Carolina will be known as Absolute Total Care as of April 1, 2021. Q: What is Absolute Total Cares Transition/Continuity of Care Policy? z4M0(th`1Lf`M18c BIcJ[%4l JU2 _ s 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. WellCare of South Carolina will be known as Absolute Total Care as of April 1, 2021. Download the free version of Adobe Reader. 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. 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. Examples: If Statement Range is March 14, 2021 through April 3, 2021, please send to WellCare. As of April 1, 2021, all WellCare of South Carolina Medicaid members will become Absolute Total Care members. We're here for you. The rules include what we must do when we get a grievance. The hearing officer will decide whether our decision was right or wrong. To avoid rejections please split the services into two separate claim submissions. An authorized representative is someone you select to act on the behalf of a member to assist them through the appeals process. 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. Can I continue to see my current WellCare members? South Carolina Department of Health and Human Services Division of Appeals and Hearings P.O. Members will need to talk to their provider right away if they want to keep seeing him/her. Awagandakami You will have a limited time to submit additional information for a fast appeal. DOS April 1, 2021 and after: Processed by Absolute Total Care. We welcome Brokers who share our commitment to compliance and member satisfaction. In South Carolina, WellCare and Absolute Total Care are joining to better serve you. Members will receive a 90-day transition of care period if the member is receiving ongoing care and treatment. 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. If at any time you need help filing one, call us. WellCare and Absolute Total Care Medicare plans will continue to operate under current brands, product names and provider contracts, until further notice. Member Sign-In. Claims for services on or after April 1, 2021 should be filed to Absolute Total Care for processing. We are proud to announce that WellCare is now part of the Centene Family. 1096 0 obj <>stream Refer to your particular provider type program chapter for clarification. Members must have Medicaid to enroll. Will Absolute Total Care change its name to WellCare? 2023 Medicare and PDP Compare Plans and Enroll Now Notice of Non-Discrimination We comply with applicable Federal civil rights laws and do not discriminate on the basis of race, color, national origin, age, sex, or disability. With quality healthcare solutions, Ambetter from Absolute Total Care helps residents of South Carolina live better. A. P.O. 1044 0 obj <> endobj Q. South Carolina DEPARTMENT OF HEALTH AND HUMAN SERVICES Post Office Box 8206 Columbia, South Carolina 29202-8206 www.scdhhs.gov November 24, 2009 ALL . A. DOSApril 1, 2021 and after: Processed by Absolute Total Care. We have licensed clinicians available to speak with you and to connect you to the support you need to feel better. If Statement Range is March 14, 2021 through April 3, 2021, please send to WellCare. 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? Finding a doctor is quick and easy. However, as of April 1, 2021, all WellCare of South Carolina Medicaid members will become Absolute Total Care members. 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. 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 Only you or your authorizedrepresentative can ask for a State Fair Hearing. The onlineProvider Manual represents the most up-to-date information on Wellcare Prime by Absolute Total Care (Medicare-Medicaid Plan), programs, policies, and procedures. P.O. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. 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. 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 South Carolina | Wellcare SOUTH CAROLINA Healthcare done well. 1,flQ*!WLOmsmz\D;I5BI,yA#z!vYQi5'fedREF40 b666q1(UtUJJ.i` (T/@E Q. Earliest From Dates prior to 4/1/2021 should be filed to WellCare of South Carolina. Timely filing limits vary. Register now at https://www.payspanhealth.comor contact PaySpan at providersupport@payspanhealth.com, or 877-331-7154. 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. 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. How do I bill a professional submission with services spanning before and after 04/01/2021? It is called a "Notice of Adverse Benefit Determination" or "NABD." WellCare is the health care plan that puts you in control. A. 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. You, your friend, a relative, legal counsel or other spokesperson who has your written consent may ask for a State Fair Hearing.