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. However, there will be no members accessing/assigned to the Medicaid portion of the agreement. How do I determine if a professional or an outpatient bill type institutional submission should be filed to WellCare or 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. Please use the From Date Institutional Statement Date. Absolute Total Care will continue to offer Marketplace products under the Ambetter brand. A. 8h} \x p`03 1z`@+`~70 G ~Ws5Puick79,4 ,O5@?O-Gr'|5Oj:v6/` WellCare Medicare members are not affected by this change. Download the free version of Adobe Reader. We are glad you joined our family! APPEALS, GRIEVANCES AND PROVIDER DISPUTES. Learn how you can help keep yourself and others healthy. First Choice can accept claim submissions via paper or electronically (EDI). You will have a limited time to submit additional information for a fast appeal. Prior authorizations issued by WellCare for dates of service on or after April 1, 2021 will transfer with the members eligibility to Absolute Total Care. B^E{h#XYQv;[ny3Hha1yx4v.sBy jWacQzyL.kHhwtQ~35!Rh#)p+sj31LcC)4*Z:IWIG@WTD- )n,! Ancillary Claims Filing Reminders; ClaimsXten TM: Correct Coding Initiative Reference Guide; Inpatient Non-Reimbursable Charges/Unbundling Policy We expect this process to be seamless for our valued members, and there will be no break in their coverage. Q. Q. WellCare Medicare Advantage Claims must be filed within 180 calendar days from the date of service. 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. Q. Additionally, WellCare will have a migration section on their provider webpage publishing FAQs. Contact Wellcare Prime Provider Service at 1-855-735-4398 if you have questions. You must ask within 30 calendar days of getting our decision. 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. Farmington, MO 63640-3821. Members can continue to receive services from their current WellCare provider as long as they remain covered under 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. 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? The participating provider agreement with WellCare will remain in-place after 4/1/2021. For general questions about claims submissions, call Provider Claims Services at 1-800-575-0418. Earliest From Dates on or after April 1, 2021 should be filed 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. Q. You or your provider must call or fax us to ask for a fast appeal. Claims will be processed according to timely filing provisions in the providers Absolute Total Care Participating Provider Agreement. However, there will be no members accessing/assigned to the Medicaid portion of the agreement. Wellcare uses cookies. Overview & Resources WellCare of North Carolina partners with providers to develop and deliver high-quality, cost-effective health care solutions. You can ask for a State Fair Hearing after we make our appeal decision. 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. Claims for services on or after April 1, 2021 should be filed to Absolute Total Care for processing. It was a smart move. It will let you know we received your appeal. z4M0(th`1Lf`M18c BIcJ[%4l JU2 _ s WellCare of North Carolina partners with providers to develop and deliver high-quality, cost-effective health care solutions. 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. A. 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. In this section, we will explain how you can tell us about these concerns/grievances. How will credentialing/recredentialing be handled by Absolute Total Care if a provider was recently credentialed/recredentialed by WellCare? Q. The onlineProvider Manual represents the most up-to-date information on Absolute Total Cares Medicaid Plan, programs, policies, and procedures. L]4(f4/pn~YTZSp-5/O*F)e~p:a6o{x8r You can do this at any time during your appeal. 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. You may request a State Fair Hearing at this address: South Carolina Department of Health %%EOF Date of Occurrence/DOSApril 1, 2021 and after: Processed by Absolute Total Care. Tampa, FL 33631-3372. Forgot Your Password? Pregnant members receiving care from an out of network Obstetrician can continue to see their current Obstetrician until after the baby is born. Our toll-free fax number is 1-877-297-3112. No, Absolute Total Care will continue to operate under the Absolute Total Care name. Q. P.O. In South Carolina, WellCare and Absolute Total Care are joining to better serve you. South Carolina | Wellcare SOUTH CAROLINA Healthcare done well. Only you or your authorizedrepresentative can ask for a State Fair Hearing. Copyright 2023 Wellcare Health Plans, Inc. No, Absolute Total Care will continue to operate under the Absolute Total Care name. 2023 Medicare and PDP Compare Plans and Enroll Now. Federal Employee Program (FEP) Federal Employee Program P.O. Absolute Total Care will honor those authorizations. Obstetrician care provided by an out of network Obstetrician will be covered for pregnant members inclusive of post-partum care. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. 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. However, there will be no members accessing/assigned to the Medicaid portion of the agreement. Absolute Total Care will continue to offer Marketplace products under the Ambetter brand. Professional and Institutional Encounter EDI transactions should be submitted to WellCare of South Carolina Medicaid with Payer ID 59354. Box 3050 Q. Your second-level review will be performed by person(s) not involved in the first review. If at any time you need help filing one, call us. Please use the earliest From Date. It is called a "Notice of Adverse Benefit Determination" or "NABD." 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. Effective January 1, 2015 the South Carolina Department of Health and Human Services (SCDHHS) will implement a Claim Reconsideration Policy. 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. Those who attend the hearing include: You can also request to have your hearing over the phone. If you are unable to view PDFs, please download Adobe Reader. Exceptions to the one-year time limit: a) Medicare Cost Sharing Claims . 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. We will send you another letter with our decision within 90 days or sooner. Awagandakami We would like to help your billing department get your EDI (claims and real time) transactions processed as efficiently as possible. 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. 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). A. We will call you with our decision if we decide you need a fast appeal. Hearings are used when you were denied a service or only part of the service was approved. Learn how you can help keep yourself and others healthy. 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. You or your authorized representative will tell the hearing officer why you think we made the wrong decision. Wfu neebybfgnh bgWfulnybfgC South Carolina Medicaid Provider Resource Guide Thank you for being a star member of our provider team. Providers are encouraged to sign up to receive EFT payments to avoid any payment delays. The provider needs to contact Absolute Total Care to arrange continuing care. Explains rules and state, line of business and CMS-specific regulations regarding 837I EDI transactions. Members will receive a 90-day transition of care period if the member is receiving ongoing care and treatment. 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. As of April 1, 2021, all WellCare of South Carolina Medicaid members will become Absolute Total Care members. 3) Coordination of Benefits. More Information Need help? At the hearing, well explain why we made our decision. 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. A. 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. These SNP plans provide benefits beyond Original Medicare, and may include transportation to medical appointments and vision exams. 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. Claims will be processed according to timely filing provisions in the providers WellCare Participating Provider Agreement. Earliest From Dates prior to 4/1/2021 should be filed to WellCare of South Carolina. We will continue covering your medical services during your appeal request and State Fair Hearing if all of the following are meet. WellCare Medicaid members migrating to Absolute Total Care will be assigned to their assigned WellCare primary care provider as if the primary care provideris in network with Absolute Total Care. 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. However, as of April 1, 2021, all WellCare of South Carolina Medicaid members will become Absolute Total Care members. Date of Occurrence/DOSprior toApril 1, 2021: Processed by WellCare. hb```b``6``e`~ "@1V NB, Need an account? 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. Providers interested in joining the Absolute Total Care vision network for routine vision services can contact Envolve Vision at 1-800-531-2818. UnitedHealthcare Dual Complete Special Needs Plan UnitedHealthcare Dual Complete Special Needs Plans (SNP) offer benefits for people with both Medicare and Medicaid. 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! As of April 1, 2021 Absolute Total Care, a Centene company, is now the health plan for South Carolina Medicaid members. 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. We cannot disenroll you from our plan or treat you differently. 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. 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. Examples: If Statement Range is March 14, 2021 through April 3, 2021, please send to WellCare. WellCare is the health care plan that puts you in control. As of April 1, 2021, WellCare will no longer be a separate plan option offered by South Carolina Healthy Connections Choices. The Medicare portion of the agreement will continue to function in its entirety as applicable. Providers can help facilitate timely claim payment by having an understanding of our processes and requirements. 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. The rules include what we must do when we get a grievance. BlueCross BlueShield of South Carolina Piedmont Service Center P.O. All Paper Claim Submissions can be mailed to: WellCare Health Plans The participating provider agreement with WellCare will remain in-place after 4/1/2021. The provider needs to contact Absolute Total Care to arrange continuing care. Incorrect forms will not be considered and may lead to further delays in processing prior authorization requests. Copyright 2023 Wellcare Health Plans, Inc. Clinical Laboratory Improvement Amendments (CLIA). You must file your appeal within 60 calendar days from the date on the NABD. 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. Call us to get this form. Timely filing is when you file a claim within a payer-determined time limit. Here are some guides we created to help you with claims filing. You can get many of your Coronavirus-related questions answered here. 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 Box 6000 Greenville, SC 29606. Coronavirus Disease 2019 (COVID-19) causes respiratory illness in people and can spread from person to person. Tampa, FL 33631-3384. We will do this as quickly as possible as but no longer than 72-hours from the decision. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. Claims will be processed according to timely filing provisions in the providers WellCare Participating Provider Agreement. With the completion of this transaction, we have created a premier healthcare enterprise focused on government-sponsored healthcare programs. The timely filing limit is the time duration from service rendered to patients and submitting claims to the insurance companies. It can also be about a provider and/or a service. They must inform their vendor of AmeriHealth Caritas . You can also have a video visit with a doctor using your phone or computer. Q. You, your friend, a relative, legal counsel or other spokesperson who has your written consent may ask for a State Fair Hearing. Outpatient Prior Authorization Form (PDF) Inpatient Prior Authorization Form (PDF) You can file a grievance by calling or writing to us. Know the facts about Coronavirus (COVID-19) Our call centers, including the nurse advice line, are currently experiencing high volume. A. Attn: Grievance Department Wellcare wants to ensure that claims are handled as efficiently as possible. \{-w{,xI202100$0*bZf ,X AayhP3pYla" e 3G& `eoT#@ *;d Q: What is Absolute Total Cares Transition/Continuity of Care Policy? The Medicare portion of the agreement will continue to function in its entirety as applicable. We want to ensure that claims are handled as efficiently as possible. 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. We understand that maintaining a healthy community starts with providing care to those who need it most. Providers are encouraged to visit the Provider Resources webpagefor manuals, forms, and resources related to claims submission, eligibility, prior authorization, and more. The materials located on our website are for dates of service prior to April 1, 2021. All dates of service on or after 4/1/2021 should be filed to Absolute Total Care. $8v + Yu @bAD`K@8m.`:DPeV @l ?-}++lz;.0U(_I]:3O'~3-~%-JM You now have access to a secure, quick way to electronically settle claims. PROVIDERS NOTE:Please send Corrected Claims as normal submissions via electronic or paper. Welcome to Wellcare By Allwell, a Medicare Advantage plan. Box 8206 Columbia, SC 29202-8206 Or call 1-800-763-9087. This manual sets forth the policies and procedures that providers participating in the Wellcare Prime network are required to follow. 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. All dates of service prior to 4/1/2021 should be filed to WellCare of South Carolina. You will need Adobe Reader to open PDFs on this site. 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 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 ask in writing for a State Fair Hearing (hearing, for short). This includes providing assistance with accessing interpreter services and hearing impaired . We expect this process to be seamless for our valued members and there will be no break in their coverage. A. Pregnant members receiving care from an out-of-network Obstetrician can continue to see their current obstetrician until after the baby is born. What will happen to unresolved claims prior to the membership transfer? The annual flu vaccine helps prevent the flu. We comply with applicable Federal civil rights laws and do not discriminate on the basis of race, color, national origin, age, sex, or disability. Members must have Medicaid to enroll. 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. As of April 1, 2021, all WellCare of South Carolina Medicaid members will become Absolute Total Care members. To avoid rejections please split the services into two separate claim submissions. Claims Department From Date Institutional Statement Dates prior to April 1, 2021 should be filed to WellCare of South Carolina. * Username. If Statement Range is April 2, 2021 through April 10, 2021, please send to Absolute Total Care. 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 . 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. We are proud to announce that WellCare is now part of the Centene Family. Finding a doctor is quick and easy. Provider can't require members to appoint them as a condition of getting services. Box 100605 Columbia, SC 29260. endstream endobj startxref 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. Please see list of services that will require authorization during this time. Claims Department A. WellCare offers participating providers EFT and ERA services at no charge through PaySpan Health. You can file your appeal by calling or writing to us. Absolute Total Care will honor those authorizations. 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. 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. Earliest From Dates on or after 4/1/2021 should be filed to Absolute Total Care. Reconsideration or Claim Disputes/Appeals: Absolute Total Care will honor all existing WellCare authorization approvals that include dates of service beyond March 31, 2021. Copyright 2023 Wellcare Health Plans, Inc. We expect this process to be seamless for our valued members, and there will be no break in their coverage. Tampa, FL 33631-3372. WellCare of South Carolina will be known as Absolute Total Care as of April 1, 2021. Box 31224
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