Members must have Medicaid to enroll. Wellcare uses cookies. A. A. Send your written appeal to: We must have your written consent before someone can file an appeal for you. (This includes your PCP or another provider.) How will credentialing/recredentialing be handled by Absolute Total Care if a provider was recently credentialed/recredentialed by WellCare? Know the facts about Coronavirus (COVID-19) Our call centers, including the nurse advice line, are currently experiencing high volume. These materials are for informational purposes only. A. The participating provider agreement with WellCare will remain in-place after 4/1/2021. You can file an appeal if you do not agree with our decision. 837 Institutional Encounter 5010v Guide March 14-March 31, 2021, please send to WellCare. You can file the grievance yourself. 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? 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. 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. Claims Submission, Correspondence and Contact Resources will stay the same for the Medicare line of business. WellCare offers participating providers EFT and ERA services at no charge through PaySpan Health. Beginning. Additionally, WellCare will have a migration section on their provider page at publishing FAQs. This gives members time to establish with a new provider in the network and ensure that they have continuity of care. For additional information, questions or concerns, please contact your local Provider Network Management Representative. In this section, we will explain how you can tell us about these concerns/grievances. Copyright 2023 Wellcare Health Plans, Inc. As of April 1, 2021, WellCare will no longer be a separate plan option offered by South Carolina Healthy Connections Choices. Box 3050 At the hearing, well explain why we made our decision. Professional and Institutional Fee-For-Service EDI transactions should be submitted to WellCare of South Carolina Medicaid with Payer ID 14163. 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. This person has all beneficiary rights and responsibilities during the appeal process. 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. Learn more about how were supporting members and providers. An appeal may be filed within 60 calendar days from the date on the Adverse Benefit Determination Notice. However, as of April 1, 2021, all WellCare of South Carolina Medicaid members will become Absolute Total Care members. Q. You can file a grievance by calling or writing to us. Members will receive a 90-day transition of care period if the member is receiving ongoing care and treatment. Thanka kaa yoa Tufrbeau ingsnh ngetfu South Caralaita nouMa mpvd. However, there will be no members accessing/assigned to the Medicaid portion of the agreement. We are committed to improving the quality of life of our millions of members, who often include some of our nations most vulnerable populations. A. You must file your appeal within 60 calendar days from the date on the NABD. WellCare understands that having access to the right tools can help you and your staff streamline day-to-day administrative tasks. To write us, send mail to: You can fax it too. All dates of service prior to April 1, 2021 should be filed to WellCare of South Carolina. hYnH~}9'I`@>cLq,&DYH"W~&eJx'"luWU]JDBFRJ!*SN(s'6# ^*dg4$SB7K4z:r6')baka+Raf4J=)l, _/jaSpao69&&_Ln=?/{:,'z .1J0|~jv4[eUN{:-gl! K'&hng?y},&X/|OzcJ@0PhDiO})9RA9tG%=|rBhHBz7 North Carolina PHP Billing Guidance for Local W Code. Because those authorizations will automatically transfer to Absolute Total Care, it is not necessary to request the authorization again when the member becomes eligible with Absolute Total Care. Q. Examples: If Statement Range is March 14, 2021 through April 3, 2021, please send to WellCare. A. Wfu neebybfgnh bgWfulnybfgC South Carolina Medicaid Provider Resource Guide Thank you for being a star member of our provider team. 0 Will my existing WellCare patients be assigned to my Absolute Total Care Panel? WellCare claims will be processed according to timely filing provisions in the providers WellCare Participating Provider Agreement. hbbd``b`$= $ Explains rules and state, line of business and CMS-specific regulations regarding 837I EDI transactions. 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. First Choice can accept claim submissions via paper or electronically (EDI). Box 600601 Columbia, SC 29260. Explains rules and state, line of business and CMS-specific regulations regarding 837P EDI transactions. 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. Providers interested in joining the Absolute Total Care Provider Network should submit a request to Network Development and Contracting via email at. The participating provider agreement with WellCare will remain in-place after April 1, 2021. We will also send you a letter with our decision within 72 hours from receiving your appeal. We will notify you orally and in writing. Q. 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. 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. 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. P.O. What will happen to my Participating Provider Agreement with WellCare after 4/1/2021? Q. A. 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. Copyright 2023 Wellcare Health Plans, Inc. Q. The second level review will follow the same process and procedure outlined for the initial review. Box 31224 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. 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. Search for primary care providers, hospitals, pharmacies, and more! 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. No, Absolute Total Care will continue to operate under the Absolute Total Care name. 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. You or your provider must call or fax us to ask for a fast appeal. However, there will be no members accessing/assigned to the Medicaid portion of the agreement. This gives members time to establish with a new provider in the network and ensure that they have continuity of care. 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. and Human Services \{-w{,xI202100$0*bZf ,X AayhP3pYla" e 3G& `eoT#@ *;d Forms. 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. Your second-level review will be performed by person(s) not involved in the first review. 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. Providers are encouraged to visit the Provider Resources webpagefor manuals, forms, and resources related to claims submission, eligibility, prior authorization, and more. Please use the earliest From Date. We must have your written permission before someone can file a grievance for you. Example of how to properly split claim that span the cutover date of April 1, 2021: Q. The Medicare portion of the agreement will continue to function in its entirety as applicable. To do this: Be sure to ask us to continue your benefits within the 10 calendar day time frame. Division of Appeals and Hearings 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. Register now. 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. Instructions on how to submit a corrected or voided claim. Q. Ancillary Claims Filing Reminders; ClaimsXten TM: Correct Coding Initiative Reference Guide; Inpatient Non-Reimbursable Charges/Unbundling Policy Earliest From Dates on or after 4/1/2021 should be filed to Absolute Total Care. The provider needs to contact Absolute Total Care to arrange continuing care. Please contact our Provider Services Call Center at 1-888-898-7969. More Information Need help? Here you will find the tools and resources you need to help manage your submission of claims and receipt of payments. You and the person you choose to represent you must sign the AOR statement. 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