Providers are encouraged to visit the Provider Resources webpagefor manuals, forms, and resources related to claims submission, eligibility, prior authorization, and more. A. 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. 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. Box 31384 Where should I submit claims for WellCare Medicaid members that transition to Absolute Total Care? Explains rules and state, line of business and CMS-specific regulations regarding 837P EDI transactions. 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. Will Absolute Total Care change its name to WellCare? 1096 0 obj <>stream Absolute Total Care will continue to offer Marketplace products under the Ambetter brand. Send your written appeal to: We must have your written consent before someone can file an appeal for you. Claims Department A. We understand that maintaining a healthy community starts with providing care to those who need it most. If you dont, we will have to deny your request. Wellcare wants to ensure that claims are handled as efficiently as possible. Members will receive a 90-day transition of care period if the member is receiving ongoing care and treatment. WellCare offers participating providers EFT and ERA services at no charge through PaySpan Health. %%EOF Box 3050 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 materials located on our website are for dates of service prior to April 1, 2021. pst/!+ Y^Ynwb7tw,eI^ An authorized representative is someone you select to act on the behalf of a member to assist them through the appeals process. Please be sure to use the correct line of business prior authorization form for prior authorization requests. We welcome Brokers who share our commitment to compliance and member satisfaction. We would like to help your billing department get your EDI (claims and real time) transactions processed as efficiently as possible. Get an annual flu shot today. You now have access to a secure, quick way to electronically settle claims. 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. We will send you another letter with our decision within 90 days or sooner. This must be done within 120 days from the date of Notice of Appeal Resolution you received from us. People of all ages can be infected. Our toll-free fax number is 1-877-297-3112. A. P.O. Only you or your authorizedrepresentative can ask for a State Fair Hearing. Timely Filing Limit: Timely Filing Limit is the time frame set by insurance companies and provider has to submit health care claims to respective insurance company within the set time frame for reimbursement of the claims. Wellcare uses cookies. $8v + Yu @bAD`K@8m.`:DPeV @l Guides Filing Claims with WellCare. Within five business days of getting your grievance, we will mail you a letter. 2023 Medicare and PDP Compare Plans and Enroll Now. Claims Department To do this: Be sure to ask us to continue your benefits within the 10 calendar day time frame. As of April 1, 2021, all WellCare of South Carolina Medicaid members will transfer to Absolute Total Care. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. Absolute Total Care will continue to offer Marketplace products under the Ambetter brand. Providers will follow Absolute Total Care Medicaid policies and procedures for all services, inclusive of medical, behavioral, and pharmaceutical benefits, provided to WellCare Medicaid members transitioning to Absolute Total Care for dates of service on or after April 1, 2021. As of April 1, 2021, all WellCare of South Carolina Medicaid members will become Absolute Total Care members. Wellcare uses cookies. Copyright 2023 WellCare Health Plans, Inc. WellCare Non-Emergency Medical Transportation (NEMT) Update, Provider Self-Service Quick Reference Guide (PDF), Provider Masters Level Proposed Rates (PDF), Member Advisory Committee (MAC) Member Flyer (PDF), Member Advisory Committee (MAC) - LTSS Member Flyer (PDF), Managed Care PHP Member PCP Change Request Form (PDF), Provider Referral Form: LTSS Request for PCS Assessment (PDF). APPEALS, GRIEVANCES AND PROVIDER DISPUTES. 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. You can file the grievance yourself. Absolute Total Care will honor those authorizations. We try to make filing claims with us as easy as possible. You or your authorized representative can review the information we used to make our decision. Claims submission, correspondence, and contact resources will stay the same for the Medicare line of business. Call us to get this form. If you need claim filing assistance, please contact your provider advocate. 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. However, there will be no members accessing/assigned to the Medicaid portion of the agreement. 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. Please use the Earliest From Date. North Carolina PHP Billing Guidance for Local W Code. Refer to your particular provider type program chapter for clarification. Ambetter from Absolute Total Care - South Carolina. All Paper Claim Submissions can be mailed to: WellCare Health Plans With quality healthcare solutions, Ambetter from Absolute Total Care helps residents of South Carolina live better. 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. Absolute Total Care will honor all existing WellCare authorization approvals that include dates of service beyond March 31, 2021. Professional and Institutional Fee-For-Service EDI transactions should be submitted to WellCare of South Carolina Medicaid with Payer ID 14163. Download the free version of Adobe Reader. Please contact our Provider Services Call Center at 1-888-898-7969. The timely filing limit is the time duration from service rendered to patients and submitting claims to the insurance companies. A. We process check runs daily, with the exception of Sundays, National Holidays, and the last day of the month. Earliest From Dates prior to 4/1/2021 should be filed to WellCare of South Carolina. Claims will be processed according to timely filing provisions in the providers Absolute Total Care Participating Provider Agreement. 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. Providers interested in joining the Absolute Total Care vision network for routine vision services can contact Envolve Vision at 1-800-531-2818. Box 6000 Greenville, SC 29606. Members must have Medicaid to enroll. 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. Box 600601 Columbia, SC 29260. Claims for services prior to April 1, 2021 should be filed to WellCare for processing. Professional and Institutional Fee-For-Service EDI transactions should be submitted to WellCare of South Carolina Medicaid with Payer ID 14163. Claim Filing Manual - First Choice by Select Health of South Carolina WellCare of South Carolina will be known as Absolute Total Care as of April 1, 2021. Electronic and Paper Claims Submissions; Institutional Claims/Encounter Guides. 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. This manual sets forth the policies and procedures that providers participating in the Wellcare Prime network are required tofollow. We expect this process to be seamless for our valued members and there will be no break in their coverage. WellCare claims will be processed according to timely filing provisions in the providers WellCare Participating Provider Agreement. The state has also helped to set the rules for making a grievance. Your second-level review will be performed by person(s) not involved in the first review. This manual sets forth the policies and procedures that providers participating in the Wellcare Prime network are required to follow. WellCare credentialing cycles will be shared with Absolute Total Care in order to reduce duplicative credentialing in the future. 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. Exceptions to the one-year time limit: a) Medicare Cost Sharing Claims . The participating provider agreement with WellCare will remain in-place after 4/1/2021. All dates of service on or after April 1, 2021 should be filed to Absolute Total Care. ?-}++lz;.0U(_I]:3O'~3-~%-JM Members will need to talk to their provider right away if they want to keep seeing him/her. Claims will be processed according to timely filing provisions in the providers WellCare Participating Provider Agreement. 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. We may apply a 14 day extension to your grievance resolution. With the completion of this transaction, we have created a premier healthcare enterprise focused on government-sponsored healthcare programs. WellCare understands that having access to the right tools can help you and your staff streamline day-to-day administrative tasks. Contact Us Y0020_WCM_100876E Last Updated On: 10/1/2022 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. Timely Filing Limits for all Insurances updated (2023) - Bcbsproviderphonenumber Timely Filing Limits for all Insurances updated (2023) One of the common and popular denials is passed the timely filing limit. The annual flu vaccine helps prevent the flu.Protect yourself and those around you. Resources #~0 I Contact Wellcare Prime Provider Service at 1-855-735-4398 if you have questions. Reimbursement Policies Outpatient Prior Authorization Form (PDF) Inpatient Prior Authorization Form (PDF)
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