The Medicare portion of the agreement will continue to function in its entirety as applicable. We will do this as quickly as possible as but no longer than 72-hours from the decision. All dates of service on or after 4/1/2021 should be filed to Absolute Total Care. In South Carolina, WellCare and Absolute Total Care are joining to better serve you. Claims Submission | BlueCross BlueShield of South Carolina This manual sets forth the policies and procedures that providers participating in the Wellcare Prime network are required to follow. WellCare of South Carolina will be known as Absolute Total Care as of April 1, 2021. Our call centers, including the nurse advice line, are currently experiencing high volume. As of April 1, 2021 Absolute Total Care, a Centene company, is now the health plan for South Carolina Medicaid members. Outpatient Prior Authorization Form (PDF) Inpatient Prior Authorization Form (PDF) If Statement Range is April 2, 2021 through April 10, 2021, please send to Absolute Total Care. Please contact our Provider Services Call Center at 1-888-898-7969. Ancillary Claims Filing Reminders; ClaimsXten TM: Correct Coding Initiative Reference Guide; Inpatient Non-Reimbursable Charges/Unbundling Policy 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. Please use the From Date Institutional Statement Date. Q. 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? Wellcare uses cookies. The benefit can be used to get more than 150 items - including vitamins, pain relievers, cold and allergy medicines, baby wipes, and diapers - at no cost . Our toll-free fax number is 1-877-297-3112. PDF AmeriHealth Caritas North Carolina If an authorization is needed, you can log in to the Secure Provider Portal at absolutetotalcare.com to submit and confirm authorizations. Q. We try to make filing claims with us as easy as possible. This gives members time to establish with a new provider in the network and ensure that they have continuity of care. Wfu neebybfgnh bgWfulnybfgC South Carolina Medicaid Provider Resource Guide Thank you for being a star member of our provider team. As of April 1, 2021, all WellCare of South Carolina Medicaid members will become Absolute Total Care members. Within five business days of getting your grievance, we will mail you a letter. South Carolina Department of Health and Human Services Division of Appeals and Hearings P.O. Providers interested in joining the Absolute Total Care Provider Network should submit a request to Network Development and Contracting via email at. Absolute Total Care will honor those authorizations. All transitioning Medicaid members will receive a welcome packet and new member 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. You now have access to a secure, quick way to electronically settle claims. You can also have a video visit with a doctor using your phone or computer. A. We will give you information to help you get the most from your benefits and the services we provide. 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). 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. South Carolina | Wellcare SOUTH CAROLINA Healthcare done well. Select Health Claims must be filed within 12 months from the date of service. 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. Please use the Earliest From Date. We expect this process to be seamless for our valued members and there will be no break in their coverage. 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. Please be sure to use the correct line of business prior authorization form for prior authorization requests. Professional and Institutional Fee-For-Service EDI transactions should be submitted to WellCare of South Carolina Medicaid with Payer ID 14163. However, there will be no members accessing/assigned to the Medicaid portion of the agreement. With the completion of this transaction, we have created a premier healthcare enterprise focused on government-sponsored healthcare programs. You may do this in writing or in person. WellCare of South Carolinawants to ensure that claims are handled as efficiently as possible. Download the free version of Adobe Reader. 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. 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. 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 Claims Guides | BlueCross BlueShield of South Carolina Visit https://msp.scdhhs.gov/appeals/ to: Copyright 2023 Wellcare Health Plans, Inc. https://msp.scdhhs.gov/appeals/site-page/file-appeal, If we deny or limit a service you or your doctor asks us to approve, If we reduce, suspend or stop services youve been getting that we already approved, If we do not pay for the health care services you get, If we fail to give services in the required timeframe, If we fail to give you a decision in the required timeframe on an appeal you already filed, If we dont agree to let you see a doctor who is not in our network and you live in a rural area or in an area with limited doctors, If you dont agree with a decision we made regarding your medicine, We denied your request to dispute a financial liability, The member did not personally receive the notice of action or received the notice late, The member was seriously ill, which prevented a timely appeal, There was a death or serious illness in the members immediate family, An accident caused important records to be destroyed, Documentation was difficult to locate within the time limits; and/or the member had incorrect or incomplete information concerning the appeals process, Change the appeal to the timeframe for a standard decision (30 calendar days), Follow up with a written letter within 2 calendar days, Tell you over the phone and in writing that you may file a grievance about the denial of the fast appeal request, Be in writing and specify the reason for the request, Include your name, address and phone number, Indicate the date of service or the type of service denied, Your authorized representative (if youve chosen one), A hearing officer from Medicaid and Long-Term Care (MLTC), You or your authorized representative with your written consent must file your appeal with us and ask to continue your benefits within 10 calendar days after we mail the Notice of Adverse benefit determination; or, Within 10 calendar days of the intended effective date of the plans proposed action, whichever is later, The appeal or hearing must address the reduction, suspension or stopping of a previously authorized service, The services were ordered by an authorized provider, The period covered by the original authorization cannot have ended. 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. 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. The Claim Reconsideration process is an informal claim review, and is not a substitute for an appeal of a final agency decision. Pharmacy services prior to 4/1/2021 must be requested from WellCare South Carolina. Beginning, March 14 March 31, 2021, please send to WellCare, April 1 April 3, 2021, please send to Absolute Total Care, DOS prior to 4/1/2021- Processed by WellCare, DOS 4/1/2021 and after- Processed by Absolute Total Care, Date of Occurrence/DOS prior to 4/1/2021- Processed by WellCare, Date of Occurrence/DOS 4/1/2021 and after- Processed by Absolute Total Care. WellCare Medicare members are not affected by this change. Keep yourself informed about Coronavirus (COVID-19.) Member Sign-In. The annual flu vaccine helps prevent the flu. 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. You will have a limited time to submit additional information for a fast appeal. $8v + Yu @bAD`K@8m.`:DPeV @l Learn how you can help keep yourself and others healthy. 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. Q. B^E{h#XYQv;[ny3Hha1yx4v.sBy jWacQzyL.kHhwtQ~35!Rh#)p+sj31LcC)4*Z:IWIG@WTD- )n,! Instructions on how to submit a corrected or voided claim. 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. They must inform their vendor of AmeriHealth Caritas . Earliest From Dates on or after 4/1/2021 should be filed to Absolute Total Care. If you dont, we will have to deny your request. If you request a hearing, the request must: A State Fair Hearing is a legal proceeding. This includes providing assistance with accessing interpreter services and hearing impaired . Filing an Appeal | South Carolina Medicaid | Absolute Total Care We are committed to improving the quality of life of our millions of members, who often include some of our nations most vulnerable populations. WellCare is the health care plan that puts you in control. PDF All Medicaid Bulletin - Sc Dhhs Federal Employee Program (FEP) Federal Employee Program P.O. Box 31224 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. 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. 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. Claims - Wellcare NC Q. Timely Filing Limits for all Insurances updated (2023) Only you or your authorizedrepresentative can ask for a State Fair Hearing. Explains how to receive, load and send 834 EDI files for member information. Explains rules and state, line of business and CMS-specific regulations regarding 837I EDI transactions. You will receive an acknowledgement letter within 5 business days, and we will send you a resolution within 90 calendar days. You may file your second level grievance review within 30 days of receiving your grievance decision letter. How are WellCare Medicaid member authorizations being handled after April 1, 2021? WellCare Health Plans, Inc. (NYSE: WCG) is now offering a $120 credit per family, per year towards over-the-counter (OTC) items as part of its Medicaid program benefits in South Carolina. Or it can be made if we take too long to make a care decision. If you are unable to view PDFs, please download Adobe Reader. Q. Explains rules and state, line of business and CMS-specific regulations regarding 837P EDI transactions. Date of Occurrence/DOSprior toApril 1, 2021: Processed by WellCare. Claim Filing Manual - First Choice by Select Health of South Carolina Obstetrician care provided by an out-of-network obstetrician will be covered for pregnant members inclusive of postpartum care. As of April 1, 2021, all WellCare of South Carolina Medicaid members will become Absolute Total Care members. March 14-March 31, 2021, please send to WellCare. We expect this process to be seamless for our valued members and there will be no break in their coverage. Obstetrician care provided by an out of network Obstetrician will be covered for pregnant members inclusive of post-partum care. These materials are for informational purposes only. We want you to let us know right away if you have any questions, grievances or problems with your covered services or the care you receive. Wellcare uses cookies. Effective January 1, 2015 the South Carolina Department of Health and Human Services (SCDHHS) will implement a Claim Reconsideration Policy. Medicaid - Wellcare NC 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. If you think you might have been exposed, contact a doctor immediately. As of April 1, 2021, WellCare will no longer be a separate plan option offered by South Carolina Healthy Connections Choices. The onlineProvider Manual represents the most up-to-date information on Wellcare Prime by Absolute Total Care (Medicare-Medicaid Plan), programs, policies, and procedures. 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 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. 941w*)bF iLK\c;nF mhk} 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. Box 6000 Greenville, SC 29606. We must have your written permission before someone can file a grievance for you. To avoid rejections please split the services into two separate claim submissions. There is a lot of insurance that follows different time frames for claim submission. 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. PDF Claim Filing Manual - First Choice by Select Health of South Carolina Call us to get this form. State Health Plan State Claims P.O. 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 hb```b``6``e`~ "@1V NB, How will credentialing/recredentialing be handled by Absolute Total Care if a provider was recently credentialed/recredentialed by WellCare? What will happen to my Participating Provider Agreement with WellCare after 4/1/2021? Register now. You can file an appeal if you do not agree with our decision. Providers are encouraged to visit the Provider Resources webpagefor manuals, forms, and resources related to claims submission, eligibility, prior authorization, and more. Timely Filing Limit of Insurances - Revenue Cycle Management endstream endobj 1045 0 obj <>/Metadata 50 0 R/OpenAction 1046 0 R/Outlines 160 0 R/Pages 1042 0 R/StructTreeRoot 166 0 R/Type/Catalog/ViewerPreferences<>>> endobj 1046 0 obj <> endobj 1047 0 obj <>/Font<>/ProcSet[/PDF/Text/ImageC/ImageB/ImageI]/XObject<>>>/Rotate 0/StructParents 0/Tabs/S/TrimBox[0.0 0.0 612.0 792.0]/Type/Page>> endobj 1048 0 obj <>stream 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. Search for primary care providers, hospitals, pharmacies, and more! We expect this process to be seamless for our valued members, and there will be no break in their coverage. Q. A. Will Absolute Total Care continue to offer Medicare and Marketplace products? A. UnitedHealthcare Dual Complete Special Needs Plan UnitedHealthcare Dual Complete Special Needs Plans (SNP) offer benefits for people with both Medicare and Medicaid. Download the free version of Adobe Reader. Example of how to properly split claim that span the cutover date of April 1, 2021: Q. Tampa, FL 33631-3384. 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. From Date Institutional Statement Dates on or after 4/1/2021 should be filed to Absolute Total Care. As of April 1, 2021, all WellCare of South Carolina Medicaid members will transfer to Absolute Total Care. 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. Awagandakami Claims | Wellcare
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