2023 Medicare and PDP Compare Plans and Enroll Now. BlueCross BlueShield of South Carolina Piedmont Service Center P.O. Download the free version of Adobe Reader. As of April 1, 2021, all WellCare of South Carolina Medicaid members will become Absolute Total Care members. It is called a "Notice of Adverse Benefit Determination" or "NABD." 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 you have another option. If at any time you need help filing one, call us. They are called: State law allows you to make a grievance if you have any problems with us. The state has also helped to set the rules for making a grievance. We are proud to announce that WellCare is now part of the Centene Family. 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. Yes, Absolute Total Care and WellCare will continue to offer Medicare products under their current brands and product names, until further notice. 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. 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. Tampa, FL 33631-3384. To earn rewards, members must: Download the Go365 for Humana Healthy Horizons app onto a mobile device from the Apple App Store or Google Play. Providers can begin requesting prior authorization for pharmacy services from Absolute Total Care for dates of service on or after April 1, 2021 from Absolute Total Care on April 1, 2021. Overview & Resources WellCare of North Carolina partners with providers to develop and deliver high-quality, cost-effective health care solutions. Providers interested in joining the Absolute Total Care Provider Network should submit a request to Network Development and Contracting via email at. Coronavirus Disease 2019 (COVID-19) causes respiratory illness in people and can spread from person to person. You may do this in writing or in person. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. You and the person you choose to represent you must sign the AOR form. 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 Provider Network should submit a request to Network Development and Contracting via email at atc_contracting@centene.com. As of April 1, 2021, all WellCare of South Carolina Medicaid members will transfer to Absolute Total Care. 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. 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. DOSApril 1, 2021 and after: Processed by Absolute Total Care. Select your topic and plan and click "Chat Now!" to chat with a live agent! 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. WellCare claims will be processed according to timely filing provisions in the providers WellCare Participating Provider Agreement. 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. 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. You will need Adobe Reader to open PDFs on this site. For additional information, questions or concerns, please contact your local Provider Network Management Representative. Explains how to receive, load and send 834 EDI files for member information. Within five business days of getting your grievance, we will mail you a letter. Welcome to Wellcare By Allwell, a Medicare Advantage plan. Professional and Institutional Encounter EDI transactions should be submitted to WellCare of South Carolina Medicaid with Payer ID 59354. WellCare credentialing cycles will be shared with Absolute Total Care in order to reduce duplicative credentialing in the future. Please use the Earliest From Date. 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. We welcome Brokers who share our commitment to compliance and member satisfaction. Q. We will give you information to help you get the most from your benefits and the services we provide. To do this: Be sure to ask us to continue your benefits within the 10 calendar day time frame. This must be done within 120 days from the date of Notice of Appeal Resolution you received from us. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. Know the facts about Coronavirus (COVID-19) Our call centers, including the nurse advice line, are currently experiencing high volume. We are committed to improving the quality of life of our millions of members, who often include some of our nations most vulnerable populations. Learn how you can help keep yourself and others healthy. How do I determine if an institutional inpatient bill type submission overlapping 4/1/2021 should be filed to WellCare or Absolute Total Care? 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. How do I join Absolute Total Cares provider network? 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. 0 A. 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. In South Carolina, WellCare and Absolute Total Care are joining to better serve you. 3) Coordination of Benefits. Kasapulam ti tulong? Additionally, WellCare will have a migration section on their provider webpage publishing FAQs. Our fax number is 1-866-201-0657. We expect this process to be seamless for our valued members, and there will be no break in their coverage. No, Absolute Total Care will continue to operate under the Absolute Total Care name. Providers are encouraged to visit the Provider Resources webpagefor manuals, forms, and resources related to claims submission, eligibility, prior authorization, and more. Download the free version of Adobe Reader. A. Box 31384 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. Incorrect forms will not be considered and may lead to further delays in processing prior authorization requests. UnitedHealthcare Dual Complete Special Needs Plan UnitedHealthcare Dual Complete Special Needs Plans (SNP) offer benefits for people with both Medicare and Medicaid. These materials are for informational purposes only. Learn how you can help keep yourself and others healthy. WellCare of South Carolina will be known as Absolute Total Care as of April 1, 2021. We are proud to announce that WellCare is now part of the Centene Family. Q. Member Sign-In. 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. Absolute Total Care will continue to offer Marketplace products under the Ambetter brand. Providers can help facilitate timely claim payment by having an understanding of our processes and requirements. Q. Please contact our Provider Services Call Center at 1-888-898-7969. More Information Coronavirus (COVID-19) (This includes your PCP or another provider.) First Choice can accept claim submissions via paper or electronically (EDI). Q. and Human Services Q: What is Absolute Total Cares Transition/Continuity of Care Policy? To avoid rejections please split the services into two separate claim submissions. 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. You can ask for a State Fair Hearing after we make our appeal decision. Please Explore the Site and Get To Know Us. However, there will be no members accessing/assigned to the Medicaid portion of the agreement. To do this: Molina Healthcare of Michigan, 100 W. Big Beaver Road, Suite 600 Attn: Claims, Troy, MI 48084-5209 Or Fax to: (248) 925-1768. The participating provider agreement with WellCare will remain in-place after 4/1/2021. 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. Go365 for Humana Healthy Horizons Members can register for the new Go365 for Humana Healthy Horizons wellness program and earn rewards for participating in healthy activities. Welcome to WellCare of South Carolina! We understand that maintaining a healthy community starts with providing care to those who need it most. Initial Claims: 120 Days from the Date of Service. Pharmacy services prior to April 1, 2021 must be requested from WellCare of South Carolina. Call us to get this form. P.O. A. How do I determine if a professional or an outpatient bill type institutional submission should be filed to WellCare or Absolute Total Care? Obstetrician care provided by an out-of-network obstetrician will be covered for pregnant members inclusive of postpartum care. Want to receive your payments faster to improve cash flow? How do I bill a professional submission with services spanning before and after 04/01/2021? 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. A. If you file a grievance or an appeal, we must be fair. L]4(f4/pn~YTZSp-5/O*F)e~p:a6o{x8r Earliest From Dates prior to 4/1/2021 should be filed to WellCare of South Carolina. 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. You, your friend, a relative, legal counsel or other spokesperson who has your written consent may ask for a State Fair Hearing. You can file the grievance yourself. Utilize interactive health and wellness tools to help you manage conditions, improve your health and save money. Box 3050 Payments mailed to providers are subject to USPS mailing timeframes. 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. To avoid rejections please split the services into two separate claim submissions. 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). Explains rules and state, line of business and CMS-specific regulations regarding 837I EDI transactions. In this section, we will explain how you can tell us about these concerns/grievances. From Date Institutional Statement Dates prior to April 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. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. Claim Filing Manual - First Choice by Select Health of South Carolina Professional and Institutional Fee-For-Service EDI transactions should be submitted to WellCare of South Carolina Medicaid with Payer ID 14163. Payments mailed to providers are subject to USPS mailing timeframes. Will Absolute Total Care continue to offer Medicare and Marketplace products? Hearings are used when you were denied a service or only part of the service was approved. Paper Claim Submission Submit paper claims to: WellCare Health Plans Electronic Claim Submission To initiate electronic claims, both in-network and out-of-network providers should contact their practice management software vendor or EDI software vendor. B^E{h#XYQv;[ny3Hha1yx4v.sBy jWacQzyL.kHhwtQ~35!Rh#)p+sj31LcC)4*Z:IWIG@WTD- )n,! You will get a letter from us when any of these actions occur. Date of Occurrence/DOSApril 1, 2021 and after: Processed by Absolute Total Care. Wellcare uses cookies. We will continue covering your medical services during your appeal request and State Fair Hearing if all of the following are meet. 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. Medicaid Claims Payment Policies We have licensed clinicians available to speak with you and to connect you to the support you need to feel better. For general questions about claims submissions, call Provider Claims Services at 1-800-575-0418. As of April 1, 2021, WellCare will no longer be a separate plan option offered by South Carolina Healthy Connections Choices. North Carolina PHP Billing Guidance for Local W Code. pst/!+ Y^Ynwb7tw,eI^ From Date Institutional Statement Dates on or after April 1, 2021 should be filed to 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. 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. A. Our health insurance programs are committed to transforming the health of the community one individual at a time. WellCare Medicare members are not affected by this change. The Medicare portion of the agreement will continue to function in its entirety as applicable. Professional and Institutional Encounter EDI transactions should be submitted to WellCare of South Carolina Medicaid with Payer ID 59354. In South Carolina, WellCare and Absolute Total Care are joining to better serve you. 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 Register now. 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 will begin to release medical payments to providers beginning July 6, 2021. To write us, send mail to: You can fax it too. We comply with applicable Federal civil rights laws and do not discriminate on the basis of race, color, national origin, age, sex, or disability. We may apply a 14 day extension to your grievance resolution. 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.

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