Reconsideration or Claim Disputes/Appeals: 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. The annual flu vaccine helps prevent the flu.Protect yourself and those around you. P.O. Absolute Total Care will honor all existing WellCare authorization approvals that include dates of service beyond March 31, 2021. The onlineProvider Manual represents the most up-to-date information on Absolute Total Cares Medicaid Plan, programs, policies, and procedures. Electronic and Paper Claims Submissions; Institutional Claims/Encounter Guides. Q. 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. the timely filing limits due to the provider being unaware of a beneficiary's coverage. Date of Occurrence/DOSprior toApril 1, 2021: Processed by WellCare. 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. 1096 0 obj <>stream B^E{h#XYQv;[ny3Hha1yx4v.sBy jWacQzyL.kHhwtQ~35!Rh#)p+sj31LcC)4*Z:IWIG@WTD- )n,! Overview & Resources WellCare of North Carolina partners with providers to develop and deliver high-quality, cost-effective health care solutions. Claims for services on or after April 1, 2021 should be filed to Absolute Total Care for processing. 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. You, your friend, a relative, legal counsel or other spokesperson who has your written consent may ask for a State Fair Hearing. As of April 1, 2021 Absolute Total Care, a Centene company, is now the health plan for South Carolina Medicaid members. A hearing officer from the State will decide if we made the right decision. Or it can be made if we take too long to make a care decision. Effective January 1, 2015 the South Carolina Department of Health and Human Services (SCDHHS) will implement a Claim Reconsideration Policy. Know the facts about Coronavirus (COVID-19) Our call centers, including the nurse advice line, are currently experiencing high volume. Here you will find the tools and resources you need to help manage your submission of claims and receipt of payments. Date of Occurrence/DOSApril 1, 2021 and after: Processed by Absolute Total Care. Additionally, WellCare will have a migration section on their provider page at publishing FAQs. and Human Services pst/!+ Y^Ynwb7tw,eI^ We cannot disenroll you from our plan or treat you differently. All dates of service on or after 4/1/2021 should be filed to Absolute Total Care. Q. We may apply a 14 day extension to your grievance resolution. Q. Yes, Absolute Total Care and WellCare will continue to offer Medicare products under their current brands and product names, until further notice. Please use the From Date Institutional Statement Date. It will let you know we received your appeal. With the completion of this transaction, we have created a premier healthcare enterprise focused on government-sponsored healthcare programs. Explains rules and state, line of business and CMS-specific regulations regarding 837I EDI transactions. Your second-level review will be performed by person(s) not involved in the first review. Absolute Total Care will honor those authorizations. This manual sets forth the policies and procedures that providers participating in the Wellcare Prime network are required to follow. We expect this process to be seamless for our valued members and there will be no break in their coverage. Please see list of services that will require authorization during this time. This gives members time to establish with a new provider in the network and ensure that they have continuity of care. How do I determine if an institutional inpatient bill type submission overlapping 4/1/2021 should be filed to WellCare or Absolute Total Care? Wellcare uses cookies. hb```b``6``e`~ "@1V NB, For dates of service on or after 4/1/2021: 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. Payments mailed to providers are subject to USPS mailing timeframes. Providers interested in joining the Absolute Total Care Provider Network should submit a request to Network Development and Contracting via email at atc_contracting@centene.com. All dates of service prior to 4/1/2021 should be filed to WellCare of South Carolina. Additionally, WellCare will have a migration section on their provider webpage publishing FAQs. 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. We expect this process to be seamless for our valued members, and there will be no break in their coverage. State Health Plan State Claims P.O. South Carolina Department of Health and Human Services Division of Appeals and Hearings P.O. 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. However, there will be no members accessing/assigned to the Medicaid portion of the agreement. 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. 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. It will tell you we received your grievance. The participating provider agreement with WellCare will remain in-place after April 1, 2021. Wellcare wants to ensure that claims are handled as efficiently as possible. In this section, we will explain how you can tell us about these concerns/grievances. To do so by phone, call Member Services at 1-888-588-9842 (TTY1-877-247-6272). 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. 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. You can get many of your Coronavirus-related questions answered here. WellCare Medicare members are not affected by this change. Earliest From Dates prior to 4/1/2021 should be filed to WellCare of South Carolina. How are WellCare Medicaid member authorizations being handled after April 1, 2021? All Paper Claim Submissions can be mailed to: WellCare Health Plans If Statement Range is April 2, 2021 through April 10, 2021, please send to Absolute Total Care. WellCare of North Carolina partners with providers to develop and deliver high-quality, cost-effective health care solutions. Explains rules and state, line of business and CMS-specific regulations regarding 837I EDI transactions. For dates of service on or after April 1, 2021: Absolute Total Care Box 31384 We will review it and send you a decision letter within 30 calendar days from receiving your appeal. Claims Submission, Correspondence and Contact Resources will stay the same for the Medicare line of business. As of April 1, 2021, WellCare will no longer be a separate plan option offered by South Carolina Healthy Connections Choices. 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. Our fax number is 1-866-201-0657. Box 31224 Timely Filing Beginning October 1, 2020, the Timely Filing submission requirements specified in each Provider's Meridian Medicare contract will be enforced. Section 1: General Information. The timely filing limit is the time duration from service rendered to patients and submitting claims to the insurance companies. Box 600601 Columbia, SC 29260. If you think you might have been exposed, contact a doctor immediately. Refer to your particular provider type program chapter for clarification. 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. 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 of North Carolina will begin to release medical payments to providers beginning July 6, 2021. For dates of service prior to April 1, 2021: All paper claim submissions can be mailed to: WellCare Health Plans Will Absolute Total Care continue to offer Medicare and Marketplace products? You can ask for a State Fair Hearing after we make our appeal decision. In South Carolina, WellCare and Absolute Total Care are joining to better serve you. 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. Box 8206 Columbia, SC 29202-8206 Or call 1-800-763-9087. Payments mailed to providers are subject to USPS mailing timeframes. Member Sign-In. If you request a hearing, the request must: A State Fair Hearing is a legal proceeding. Register now. Copyright 2023 Wellcare Health Plans, Inc. Clinical Laboratory Improvement Amendments (CLIA). Providers can help facilitate timely claim payment by having an understanding of our processes and requirements. Tampa, FL 33631-3384. P.O. With the completion of this transaction, we have created a premier healthcare enterprise focused on government-sponsored healthcare programs. 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. * Username. How do I determine if a professional or an outpatient bill type institutional submission should be filed to WellCare or Absolute Total Care? Register now at https://www.payspanhealth.com or contact PaySpan at providersupport@payspanhealth.com, or 877-331-7154. Pharmacy services prior to 4/1/2021 must be requested from WellCare South Carolina. If you dont, we will have to deny your request. 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. Q. 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 A. Explains rules and state, line of business and CMS-specific regulations regarding 837P EDI transactions. More Information Coronavirus (COVID-19) Addakam ditoy para kenka. In South Carolina, WellCare and Absolute Total Care are joining to better serve you. 2) Reconsideration or Claim disputes/Appeals. Can I continue to see my current WellCare members? Resources 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. 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. 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 . 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. Box 3050 941w*)bF iLK\c;nF mhk} To avoid rejections please split the services into two separate claim submissions. No, Absolute Total Care will continue to operate under the Absolute Total Care name. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. A. Q. 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 For the latest COVID-19 news, visit the CDC. Members will receive a 90-day transition of care period if the member is receiving ongoing care and treatment. With the completion of this transaction, we have created a premier healthcare enterprise focused on government-sponsored healthcare programs. Instructions on how to submit a corrected or voided claim. 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. Q. The provider needs to contact Absolute Total Care to arrange continuing care. WellCare of South Carolinawants to ensure that claims are handled as efficiently as possible. 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). Ancillary Claims Filing Reminders; ClaimsXten TM: Correct Coding Initiative Reference Guide; Inpatient Non-Reimbursable Charges/Unbundling Policy You will get a letter from us when any of these actions occur. Providers are encouraged to visit the Provider Resources webpagefor manuals, forms, and resources related to claims submission, eligibility, prior authorization, and more. Earliest From Dates on or after 4/1/2021 should be filed to Absolute Total Care. WellCare and Absolute Total Care Medicare plans will continue to operate under current brands, product names and provider contracts, until further notice. 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. Want to receive your payments faster to improve cash flow? Only you or your authorizedrepresentative can ask for a State Fair Hearing. Wellcare uses cookies. Providers can help facilitate timely claim payment by having an understanding of our processes and requirements. We will also send you a letter with our decision within 72 hours from receiving your appeal. We will send you another letter with our decision within 90 days or sooner. 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. Earliest From Dates on or after April 1, 2021 should be filed to Absolute Total Care. 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. A. Attn: Grievance Department WellCare is the health care plan that puts you in control. 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. You will need Adobe Reader to open PDFs on this site. 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 Medicare portion of the agreement will continue to function in its entirety as applicable. Claims for services prior to April 1, 2021 should be filed to WellCare for processing. P.O. Division of Appeals and Hearings 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. Download the free version of Adobe Reader. Absolute Total Care will continue to offer Marketplace products under the Ambetter brand. This person has all beneficiary rights and responsibilities during the appeal process. Q. 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. To have someone represent you, you must complete an Appointment of Representative (AOR) form. Finding a doctor is quick and easy. They are called: State law allows you to make a grievance if you have any problems with us. For example, if any patient gets services on the 1st of any month then there is a time limit to submit his/her claim to the insurance company for reimbursement. Always verify timely filing requirements with the third party payor. A. Ambetter Timely Filing Limit of : 1) Initial Claims. Explains rules and state, line of business and CMS-specific regulations regarding 837I EDI transactions. WellCare offers participating providers EFT and ERA services at no charge through PaySpan Health. You will have a limited time to submit additional information for a fast appeal. It is called a "Notice of Adverse Benefit Determination" or "NABD." This manual sets forth the policies and procedures that providers participating in the Absolute Total Carenetwork are required tofollow. 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. Contact Absolute Total Care Provider Service at1-866-433-6041if youhave questions. Wellcare uses cookies. Claims will be processed according to timely filing provisions in the providers Absolute Total Care Participating Provider Agreement. You or your provider must call or fax us to ask for a fast appeal. UnitedHealthcare Dual Complete Special Needs Plan UnitedHealthcare Dual Complete Special Needs Plans (SNP) offer benefits for people with both Medicare and Medicaid. Q. 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. DOS April 1, 2021 and after: Processed by Absolute Total Care. We will notify you orally and in writing. Members will need to talk to their provider right away if they want to keep seeing him/her. We are committed to improving the quality of life of our millions of members, who often include some of our nations most vulnerable populations. (This includes your PCP or another provider.) 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. * Password. Copyright 2023 Wellcare Health Plans, Inc. Box 3050 The second level review will follow the same process and procedure outlined for the initial review. 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.