However, there will be no members accessing/assigned to the Medicaid portion of the agreement. 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. These SNP plans provide benefits beyond Original Medicare, and may include transportation to medical appointments and vision exams. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. WellCare has partnered with Change Healthcare as our preferred EDI Clearinghouse. 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, 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. Claims will be processed according to timely filing provisions in the providers WellCare Participating Provider Agreement. Medicaid Claims Payment Policies WellCare of South Carolina will be known as Absolute Total Care as of April 1, 2021. B^E{h#XYQv;[ny3Hha1yx4v.sBy jWacQzyL.kHhwtQ~35!Rh#)p+sj31LcC)4*Z:IWIG@WTD- )n,! A. WellCare credentialing cycles will be shared with Absolute Total Care in order to reduce duplicative credentialing in the future. This manual sets forth the policies and procedures that providers participating in the Absolute Total Carenetwork are required tofollow. Welcome to Wellcare By Allwell, a Medicare Advantage plan. P.O. Claims | Wellcare 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. Authorizations already processed by WellCare for any services on or after April 1, 2021, will be moved to Absolute Total Care and there is no need for the provider or member to request these services again. $8v + Yu @bAD`K@8m.`:DPeV @l Wellcare uses cookies. WellCare offers participating providers EFT and ERA services at no charge through PaySpan Health. WellCare understands that having access to the right tools can help you and your staff streamline day-to-day administrative tasks. You will receive an acknowledgement letter within 5 business days, and we will send you a resolution within 90 calendar days. Providers interested in joining the Absolute Total Care vision network for routine vision services can contact Envolve Vision at 1-800-531-2818. Q. How do I determine if an institutional inpatient bill type submission overlapping 4/1/2021 should be filed to WellCare or Absolute Total Care? Members will receive a 90-day transition of care period if the member is receiving ongoing care and treatment. Professional and Institutional Encounter EDI transactions should be submitted to WellCare of South Carolina Medicaid with Payer ID 59354. Members will receive a 90-day transition of care period if the member is receiving ongoing care and treatment. April 1-April 3, 2021, please send to Absolute Total Care. We are glad you joined our family! It is called a "Notice of Adverse Benefit Determination" or "NABD." WellCare offers participating providers EFT and ERA services at no charge through PaySpan Health. Explains rules and state, line of business and CMS-specific regulations regarding 837P EDI transactions. The materials located on our website are for dates of service prior to April 1, 2021. 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. Obstetrician care provided by an out of network Obstetrician will be covered for pregnant members inclusive of post-partum care. Provider Manuals and Forms | Absolute Total Care Our toll-free fax number is 1-877-297-3112. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. 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. Please use the earliest From Date. We may apply a 14 day extension to your grievance resolution. Members will need to talk to their provider right away if they want to keep seeing him/her. #~0 I Download the free version of Adobe Reader. 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. Guides Filing Claims with WellCare. You can file the grievance yourself. You may request a State Fair Hearing at this address: South Carolina Department of Health Always verify timely filing requirements with the third party payor. Select your topic and plan and click "Chat Now!" to chat with a live agent! Explains rules and state, line of business and CMS-specific regulations regarding 837I EDI transactions. Providers will continue to follow WellCares Medicaid policies and procedures for services provided to WellCare Medicaid members for dates of service prior to April 1, 2021. Claims for services on or after April 1, 2021 should be filed to Absolute Total Care for processing. What will happen to my Participating Provider Agreement with WellCare after 4/1/2021? 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). Instructions on how to submit a corrected or voided claim. 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. What is the Rx BIN and Group Number for WellCare members transitioning to Absolute Total Care on April 1, 2021? If you need claim filing assistance, please contact your provider advocate. %%EOF Contact Absolute Total Care Provider Service at1-866-433-6041if youhave questions. To do so by phone, call Member Services at 1-888-588-9842 (TTY1-877-247-6272). You or your authorized representative can review the information we used to make our decision. Or it can be made if we take too long to make a care decision. Finding a doctor is quick and easy. Timely Filing Limits - Health Network Solutions 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! From Date Institutional Statement Dates on or after 4/1/2021 should be filed to Absolute Total Care. Where should I submit claims for WellCare Medicaid members? 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. Earliest From Dates on or after April 1, 2021 should be filed to Absolute Total Care. A. Q. 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. Explains rules and state, line of business and CMS-specific regulations regarding 837I EDI transactions. We will call you with our decision if we decide you need a fast appeal. As of April 1, 2021, WellCare will no longer be a separate plan option offered by South Carolina Healthy Connections Choices. Awagandakami The annual flu vaccine helps prevent the flu.Protect yourself and those around you. What will happen to unresolved claims prior to the membership transfer? Utilize interactive health and wellness tools to help you manage conditions, improve your health and save money. Box 3050 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? To write us, send mail to: You can fax it too. It can also be about a provider and/or a service. 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. A. WellCare of North Carolina partners with providers to develop and deliver high-quality, cost-effective health care solutions. A. Claims - Wellcare NC DOSApril 1, 2021 and after: Processed by Absolute Total Care. 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. You can file an appeal if you do not agree with our decision. We welcome Brokers who share our commitment to compliance and member satisfaction. We expect this process to be seamless for our valued members, and there will be no break in their coverage. 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? South Carolina | Wellcare Welcome to WellCare of South Carolina | Wellcare If Statement Range is April 2, 2021 through April 10, 2021, please send to Absolute Total Care. For as long as your member has an active WellCare subscriber number, you should continue to submit claims directly to WellCare as you have in the past. Members can continue to receive services from their current WellCare provider as long as they remain covered under WellCare. We expect this process to be seamless for our valued members and there will be no break in their coverage. The state has also helped to set the rules for making a grievance. 1044 0 obj <> endobj 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. z4M0(th`1Lf`M18c BIcJ[%4l JU2 _ s Payments mailed to providers are subject to USPS mailing timeframes. It was a smart move. We will notify you orally and in writing. S< 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. There is a lot of insurance that follows different time frames for claim submission. Providers can help facilitate timely claim payment by having an understanding of our processes and requirements. This person has all beneficiary rights and responsibilities during the appeal process. 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. If at any time you need help filing one, call us. Claims and billing - Select Health of SC At the hearing, well explain why we made our decision. 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. 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
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