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Resources Where should I submit claims for WellCare Medicaid members that transition to Absolute Total Care? Claims Guides | BlueCross BlueShield of South Carolina However, there will be no members accessing/assigned to the Medicaid portion of the agreement. Farmington, MO 63640-3821. Professional and Institutional Fee-For-Service EDI transactions should be submitted to WellCare of South Carolina Medicaid with Payer ID 14163. 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. If you need assistance with your appeal please call Absolute Total Care at 1-866-433-6041 (TTY: 711) and we will assist you in filing your appeal. Explains rules and state, line of business and CMS-specific regulations regarding 837I EDI transactions. Medicaid - Wellcare NC Explains rules and state, line of business and CMS-specific regulations regarding 837P EDI transactions. 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. Download the free version of Adobe Reader. Explains rules and state, line of business and CMS-specific regulations regarding 837P EDI transactions. We would like to help your billing department get your EDI (claims and real time) transactions processed as efficiently as possible. Initial Claims: 120 Days from the Date of Service. Awagandakami The hearing officer does not decide in your favor. To do this: Be sure to ask us to continue your benefits within the 10 calendar day time frame. If you need claim filing assistance, please contact your provider advocate. 3) Coordination of Benefits. How are WellCare Medicaid member authorizations being handled after April 1, 2021? Coronavirus Disease 2019 (COVID-19) causes respiratory illness in people and can spread from person to person. We understand that maintaining a healthy community starts with providing care to those who need it most. Please be sure to use the correct line of business prior authorization form for prior authorization requests. Forgot Your Password? WellCare claims will be processed according to timely filing provisions in the providers WellCare Participating Provider Agreement. Tampa, FL 33631-3372. These SNP plans provide benefits beyond Original Medicare, and may include transportation to medical appointments and vision exams. Search for primary care providers, hospitals, pharmacies, and more! Members will need to talk to their provider right away if they want to keep seeing him/her. 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. Finding a doctor is quick and easy. We process check runs daily, with the exception of Sundays, National Holidays, and the last day of the month. 941w*)bF iLK\c;nF mhk} Register now at https://www.payspanhealth.com or contact PaySpan at providersupport@payspanhealth.com, or 877-331-7154. Payments mailed to providers are subject to USPS mailing timeframes. The annual flu vaccine helps prevent the flu. Examples: If Statement Range is March 14, 2021 through April 3, 2021, please send to WellCare. 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). Copyright 2023 Wellcare Health Plans, Inc. We cannot disenroll you from our plan or treat you differently. Timely Filing Limit of Insurances - Revenue Cycle Management Q. Please use the From Date Institutional Statement Date. The second level review will follow the same process and procedure outlined for the initial review. We try to make filing claims with us as easy as possible. What is the Rx BIN and Group Number for WellCare members transitioning to Absolute Total Care on April 1, 2021? Q. You will receive an acknowledgement letter within 5 business days, and we will send you a resolution within 90 calendar days. Claims will be processed according to timely filing provisions in the providers Absolute Total Care Participating Provider Agreement. S< A hearing officer from the State will decide if we made the right decision. State Health Plan State Claims P.O. 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 will also send you a letter with our decision within 72 hours from receiving your appeal. Box 100605 Columbia, SC 29260. At the hearing, well explain why we made our decision. Home | Wellcare 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. Refer to your particular provider type program chapter for clarification. 1071 0 obj <>/Filter/FlateDecode/ID[<87133B316ADA4BDD8B85BA48A489D34F>]/Index[1044 53]/Info 1043 0 R/Length 117/Prev 692690/Root 1045 0 R/Size 1097/Type/XRef/W[1 2 1]>>stream Check out the Interoperability Page to learn more. 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. * Password. 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. Prior authorizations issued by WellCare for dates of service on or after 4/1/2021 will transfer with the members eligibility to Absolute Total Care. Overview & Resources WellCare of North Carolina partners with providers to develop and deliver high-quality, cost-effective health care solutions. If you dont agree with our appeal decision - and you've completed the appeal steps with our health plan - or, if our appeal decision was not made within the required timeframe (30-calendar days for standard appeals or 72 hours for fast appeals), you may request a State Fair Hearing. Claims | Wellcare Will WellCare continue to offer current products or Medicare only? Wfu neebybfgnh bgWfulnybfgC South Carolina Medicaid Provider Resource Guide Thank you for being a star member of our provider team. Or it can be made if we take too long to make a care decision. 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. We expect this process to be seamless for our valued members, and there will be no break in their coverage. z4M0(th`1Lf`M18c BIcJ[%4l JU2 _ s 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. Q. Guides Filing Claims with WellCare. WellCare offers participating providers EFT and ERA services at no charge through PaySpan Health. To ask for hearing, call 1-800-763-9087 or write to: You also can make a request online using SCDHHS form at https://msp.scdhhs.gov/appeals/site-page/file-appeal. Division of Appeals and Hearings 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. To do this: Absolute Total Care will continue to offer Marketplace products under the Ambetter brand. This must be done within 120 days from the date of Notice of Appeal Resolution you received from us. At WellCare, we value everything you do to deliver quality care to our members your patients and ensure they have a positive health care experience. With quality healthcare solutions, Ambetter from Absolute Total Care helps residents of South Carolina live better. Our health insurance programs are committed to transforming the health of the community one individual at a time. Timely Filing Beginning October 1, 2020, the Timely Filing submission requirements specified in each Provider's Meridian Medicare contract will be enforced. If you wish to use a representative, then he or she must complete an Appointment of Representative (AOR) statement. endstream endobj startxref You and the person you choose to represent you must sign the AOR form. A. South Carolina Medicaid & Health Insurance | Absolute Total Care However, as of April 1, 2021, all WellCare of South Carolina Medicaid members will become Absolute Total Care members. 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. Medicaid North Carolina | Healthy Blue of North Carolina ?-}++lz;.0U(_I]:3O'~3-~%-JM Wellcare uses cookies. Claim Reconsideration Policy-Fee For Service (FFS) Medicaid You will get a letter from us when any of these actions occur. Member Appeals (Medical, Behavioral Health, and Pharmacy): You will need Adobe Reader to open PDFs on this site. Section 1: General Information. $8v + Yu @bAD`K@8m.`:DPeV @l Claims will be processed according to timely filing provisions in the providers WellCare Participating Provider Agreement. 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. 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. Prior authorizations issued by WellCare for dates of service on or after 4/1/2021 will transfer with the members eligibility to Absolute Total Care. Claims will be processed according to timely filing provisions in the providers Absolute Total Care Participating Provider Agreement. In South Carolina, WellCare and Absolute Total Care are joining to better serve you. From Date Institutional Statement Dates on or after April 1, 2021 should be filed to Absolute Total Care. Q. This manual sets forth the policies and procedures that providers participating in the Wellcare Prime network are required to follow. A grievance is when you tell us about a concern you have with our plan. Claims Department A. Tampa, FL 33631-3372. A. Welcome to WellCare of South Carolina! These grievances may be about: The state of South Carolina allows members to file a grievance at anytime from the event that caused the dissatisfaction. As of April 1, 2021 Absolute Total Care, a Centene company, is now the health plan for South Carolina Medicaid members. To do so by phone, call Member Services at 1-888-588-9842 (TTY1-877-247-6272). DOS prior toApril 1, 2021: Processed by WellCare. What is UnitedHealthcare timely filing limit? - Sage-Answer 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. Box 31384 South Carolina Department of Health and Human Services Division of Appeals and Hearings P.O. The materials located on our website are for dates of service prior to April 1, 2021. hbbd``b`$= $ 837 Institutional Encounter 5010v Guide What will happen to unresolved claims prior to the membership transfer? 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. A. WellCare Medicaid members migrating to Absolute Total Care will be assigned to their assigned WellCare Primary Care Physician (PCP) as if the PCP is in network with Absolute Total Care. WellCare credentialing cycles will be shared with Absolute Total Care in order to reduce duplicative credentialing in the future. Wellcare wants to ensure that claims are handled as efficiently as possible. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. You can file the grievance yourself. Claim Filing Manual - First Choice by Select Health of South Carolina If you think you might have been exposed, contact a doctor immediately. We comply with applicable Federal civil rights laws and do not discriminate on the basis of race, color, national origin, age, sex, or disability. L]4(f4/pn~YTZSp-5/O*F)e~p:a6o{x8r All dates of service prior to April 1, 2021 should be filed to WellCare of South Carolina. How do I determine if a professional or an outpatient bill type institutional submission should be filed to WellCare or Absolute Total Care? 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. 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. Written notice is not needed if your expedited appeal request is filed verbally. 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. North Carolina PHP Billing Guidance for Local W Code. 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. Absolute Total Care Box 6000 Greenville, SC 29606. 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. Q. Timely Filing Limits for all Insurances updated (2023) When to File Claims | Cigna 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. To avoid rejections please split the services into two separate claim submissions. 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. Absolute Total Care will utilize credentialing cycles from WellCare and Absolute Total Care so that providers will only need to credential once every three years. 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. With the completion of this transaction, we have created a premier healthcare enterprise focused on government-sponsored healthcare programs. Ambetter Timely Filing Limit of : 1) Initial Claims. 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 of South Carolina will be known as Absolute Total Care as of April 1, 2021. Utilize interactive health and wellness tools to help you manage conditions, improve your health and save money. 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. 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. As of April 1, 2021, all WellCare of South Carolina Medicaid members will become Absolute Total Care members. If Statement Range is April 2, 2021 through April 10, 2021, please send to Absolute Total Care. P.O. Electronic and Paper Claims Submissions; Institutional Claims/Encounter Guides. Claims | Wellcare A. If you file a grievance or an appeal, we must be fair. With the completion of this transaction, we have created a premier healthcare enterprise focused on government-sponsored healthcare programs. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. For dates of service prior to April 1, 2021: All paper claim submissions can be mailed to: WellCare Health Plans Exceptions to the one-year time limit: a) Medicare Cost Sharing Claims .