South Carolina Department of Health and Human Services Division of Appeals and Hearings P.O. Provider can't require members to appoint them as a condition of getting services. 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. Awagandakami UHC Community TFL - Timely filing Limit: 120 Days: Unitedhealthcare TFL - Timely filing Limit: Participating Providers: 90 days Non Participating Providers: 180 Days If its secondary payer: 90 days from date of Primary Explanation of Benefits Unitedhealthcare timely filing limit for appeals: 12 months from original claim determination Claims and billing - Select Health of SC B^E{h#XYQv;[ny3Hha1yx4v.sBy jWacQzyL.kHhwtQ~35!Rh#)p+sj31LcC)4*Z:IWIG@WTD- )n,! 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. Where should I submit claims for WellCare Medicaid members? WellCare and Absolute Total Care Medicare plans will continue to operate under current brands, product names and provider contracts, until further notice. 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. We understand that maintaining a healthy community starts with providing care to those who need it most. 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. We will call you with our decision if we decide you need a fast appeal. If Statement Range is April 2, 2021 through April 10, 2021, please send to Absolute Total Care. How will credentialing/recredentialing be handled by Absolute Total Care if a provider was recently credentialed/recredentialed by WellCare? To do so by phone, call Member Services at 1-888-588-9842 (TTY1-877-247-6272). Professional and Institutional Fee-For-Service EDI transactions should be submitted to WellCare of South Carolina Medicaid with Payer ID 14163. P.O. Absolute Total Care will continue to offer Marketplace products under the Ambetter brand. South Carolina Medicaid Provider Documents - Humana More Information Need help? 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. However, there will be no members accessing/assigned to the Medicaid portion of the agreement. We welcome Brokers who share our commitment to compliance and member satisfaction. A provider can act for a member in hearings with the member's written permission in advance. ?-}++lz;.0U(_I]:3O'~3-~%-JM Q. What is the Rx BIN and Group Number for WellCare members transitioning to Absolute Total Care on April 1, 2021? 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. Additionally, WellCare will have a migration section on their provider page at publishing FAQs. It will let you know we received your appeal. 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. No, Absolute Total Care will continue to operate under the Absolute Total Care name. WellCare of South Carolina will be known as Absolute Total Care as of April 1, 2021. You may file your second level grievance review within 30 days of receiving your grievance decision letter. With the completion of this transaction, we have created a premier healthcare enterprise focused on government-sponsored healthcare programs. Payments mailed to providers are subject to USPS mailing timeframes. Claims for services on or after April 1, 2021 should be filed to Absolute Total Care for processing. When to File Claims | Cigna Q. From Date Institutional Statement Dates on or after April 1, 2021 should be filed to Absolute Total Care. A. You or your authorized representative can review the information we used to make our decision. Please be sure to use the correct line of business prior authorization form for prior authorization requests. You will have a limited time to submit additional information for a fast appeal. You may do this in writing or in person. A. First Choice can accept claim submissions via paper or electronically (EDI). The state has also helped to set the rules for making a grievance. Contact Us Y0020_WCM_100876E Last Updated On: 10/1/2022 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. We will review it and send you a decision letter within 30 calendar days from receiving your appeal. If you need claim filing assistance, please contact your provider advocate. South Carolina | Wellcare 2023 Medicare and PDP Compare Plans and Enroll Now Notice of Non-Discrimination We comply with applicable Federal civil rights laws and do not discriminate on the basis of race, color, national origin, age, sex, or disability. Claim Filing Manual - First Choice by Select Health of South Carolina P.O. All billing requirements must be adher ed to by the provider in order to ensure timely processing of claims. With the completion of this transaction, we have created a premier healthcare enterprise focused on government-sponsored healthcare programs. English - Wellcare NC N .7$* P!70 *I;Rox3 ] LS~. Farmington, MO 63640-3821. 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. 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. An appeal is a request you can make when you do not agree with a decision we made about your care. Claims Submission, Correspondence and Contact Resources will stay the same for the Medicare line of business. Q: What is Absolute Total Cares Transition/Continuity of Care Policy? Explains rules and state, line of business and CMS-specific regulations regarding 837I EDI transactions. WellCare Offers New Over-The-Counter Benefit To Its South Carolina 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. Know the facts about Coronavirus (COVID-19) Our call centers, including the nurse advice line, are currently experiencing high volume. Q. WellCare offers participating providers EFT and ERA services at no charge through PaySpan Health. A grievance is when you tell us about a concern you have with our plan. The timely filing limit is the time duration from service rendered to patients and submitting claims to the insurance companies. For current information, visit the Absolute Total Care website. Here are some guides we created to help you with claims filing. Explains how to receive, load and send 834 EDI files for member information. Utilize interactive health and wellness tools to help you manage conditions, improve your health and save money. A. We comply with applicable Federal civil rights laws and do not discriminate on the basis of race, color, national origin, age, sex, or disability. 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. Please use the From Date Institutional Statement Date. The annual flu vaccine helps prevent the flu. 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. We cannot disenroll you from our plan or treat you differently. 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 healthcare services starting April 1, 2021. Obstetrician care provided by an out of network Obstetrician will be covered for pregnant members inclusive of post-partum care. The participating provider agreement with WellCare will remain in-place after April 1, 2021. Q. What is Molina Healthcare timely filing limit? - Short-Question Timely Filing Limits - Health Network Solutions Our fax number is 1-866-201-0657. South Carolina Medicaid & Health Insurance | Absolute Total Care To have someone represent you, you must complete an Appointment of Representative (AOR) form. Providers interested in joining the Absolute Total Care vision network for routine vision services can contact Envolve Vision at 1-800-531-2818. We are simplifying Medicare so you can choose and use an affordable local plan that will help you achieve your best possible health. Timely Filing Limits for all Insurances updated (2023) Register now. Register now at https://www.payspanhealth.com or contact PaySpan at providersupport@payspanhealth.com, or 877-331-7154. No, Absolute Total Care will continue to operate under the Absolute Total Care name. 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. How are WellCare Medicaid member authorizations being handled after April 1, 2021? $8v + Yu @bAD`K@8m.`:DPeV @l To do so by phone, call Member Services at 1-888-588-9842 (TTY1-877-247-6272). The Medicare portion of the agreement will continue to function in its entirety as applicable. 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. 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. 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. All dates of service on or after 4/1/2021 should be filed to Absolute Total Care. We want to ensure that claims are handled as efficiently as possible. Managed Care Claims and Prior Authorizations Submission - NCDHHS 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. We are committed to improving the quality of life of our millions of members, who often include some of our nations most vulnerable populations. HealthPlan - redirect.centene.com - Allwell Medicare How do I bill a professional submission with services spanning before and after 04/01/2021? Providers can begin requesting prior authorization from Absolute Total Care for dates of service on or after April 1, 2021 from Absolute Total Care on March 15, 2021. 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. Initial Claims: 120 Days from the Date of Service. Absolute Total Care will continue to offer Marketplace products under the Ambetter brand. WellCare has partnered with Change Healthcare as our preferred EDI Clearinghouse. The Claim Reconsideration process is an informal claim review, and is not a substitute for an appeal of a final agency decision. The participating provider agreement with WellCare will remain in-place after 4/1/2021. We expect this process to be seamless for our valued members, and there will be no break in their coverage. Attn: Grievance Department 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 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. We expect this process to be seamless for our valued members and there will be no break in their coverage. 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. Box 3050 South Carolina DEPARTMENT OF HEALTH AND HUMAN SERVICES Post Office Box 8206 Columbia, South Carolina 29202-8206 www.scdhhs.gov November 24, 2009 ALL . Get an annual flu shot today. Q. State Health Plan State Claims P.O. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. What is UnitedHealthcare timely filing limit? - Sage-Answer Will WellCare continue to offer current products or Medicare only? That's why we provide tools and resources to help. 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. R 1/70.3/Determining End Date of Timely Filing Period -- Receipt Date R 1/70.4/Determination of Untimely Filing and Resulting Actions R 1/70.5/Application to Special Claim Types R 1/70.6/Filing Claim Where General Time Limit Has Expired R 1/70.7/Exceptions Allowing Extension of Time Limit R 1/70.7.1/Administrative Error As of April 1, 2021, all WellCare of South Carolina Medicaid members will transfer to Absolute Total Care. For dates of service prior to April 1, 2021: All paper claim submissions can be mailed to: WellCare Health Plans 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. Absolute Total Care will honor those authorizations. A. Can I continue to see my current WellCare members? An appeal may be filed within 60 calendar days from the date on the Adverse Benefit Determination Notice. You may request a State Fair Hearing at this address: South Carolina Department of Health 2023 Medicare and PDP Compare Plans and Enroll Now. Please contact our Provider Services Call Center at 1-888-898-7969. In this section, we will explain how you can tell us about these concerns/grievances. Providers can help facilitate timely claim payment by having an understanding of our processes and requirements. Select Health Claims must be filed within 12 months from the date of service. 1096 0 obj <>stream Q. You can file an appeal if you do not agree with our decision. A. A. 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. 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. South Carolina | Medicaid It was a smart move. Please use WellCare Payor ID 14163. They must inform their vendor of AmeriHealth Caritas . Wellcare wants to ensure that claims are handled as efficiently as possible. The member will be encouraged to establish care with a new in network primary care provider/specialist prior to the end of the transition/continuity of care period to review present treatment plan and coordinate the member's medical care. * Username. Resources Claim Reconsideration Policy-Fee For Service (FFS) Medicaid There is a lot of insurance that follows different time frames for claim submission. You must file your appeal within 60 calendar days from the date on the NABD. Claims Department A. The hearing officer does not decide in your favor. Absolute Total Care will honor those authorizations. Download the free version of Adobe Reader. Welcome to WellCare of South Carolina! By continuing to use our site, you agree to our Privacy Policy and Terms of Use. Medicaid - Wellcare NC Contact Wellcare Prime Provider Service at1-855-735-4398if youhave questions. For dates of service on or after April 1, 2021: Absolute Total Care Overview & Resources WellCare of North Carolina partners with providers to develop and deliver high-quality, cost-effective health care solutions. Box 6000 Greenville, SC 29606. 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. We will continue covering your medical services during your appeal request and State Fair Hearing if all of the following are meet. From Date Institutional Statement Dates on or after 4/1/2021 should be filed to Absolute Total Care. 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. WellCare of South Carolina will be known as Absolute Total Care as of April 1, 2021. Timely filing is when you file a claim within a payer-determined time limit. Member Appeals (Medical, Behavioral Health, and Pharmacy): You will need Adobe Reader to open PDFs on this site. Example of how to properly split claim that span the cutover date of April 1, 2021: Q. 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. 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. Integration FAQs | Absolute Total Care The onlineProvider Manual represents the most up-to-date information on Wellcare Prime by Absolute Total Care (Medicare-Medicaid Plan), programs, policies, and procedures. Search for primary care providers, hospitals, pharmacies, and more! 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. Click below for more information from Absolute Total Care: You are now able to view your health information from a third-party app on a mobile device or PC! Claims will be processed according to timely filing provisions in the providers WellCare Participating Provider Agreement. A. If you dont, we will have to deny your request. Want to receive your payments faster to improve cash flow? Members can continue to receive services from their current WellCare provider as long as they remain covered under WellCare. Outpatient Prior Authorization Form (PDF) Inpatient Prior Authorization Form (PDF) Tampa, FL 33631-3372. This person has all beneficiary rights and responsibilities during the appeal process. Pregnant members receiving care from an out-of-network Obstetrician can continue to see their current obstetrician until after the baby is born. you have another option. A. Symptoms are flu-like, including: Fever Coughing Explains how to receive, load and send 834 EDI files for member information. Box 600601 Columbia, SC 29260. Box 8206 Q. PROVIDER REMINDER: It is important that providers check eligibility prior to providing services as members can potentially change plans prior to 4/1/2021 if they are in the annual choice period. You can also have a video visit with a doctor using your phone or computer. As a member you may request a 14 day extension of your grievance, you may do so by calling Member Services at 1-888-588-9842 (TTY 1-877-247-6272) or You may send your request for extension in writing to: WellCare Health Plans WellCare claims will be processed according to timely filing provisions in the providers WellCare Participating Provider Agreement. North Carolina PHP Billing Guidance for Local W Code. For as long as your member has an active WellCare subscriber number, you should continue to submit claims directly to WellCare as you have in the past. Date of Occurrence/DOSApril 1, 2021 and after: Processed by Absolute Total Care. A. Pharmacy services prior to 4/1/2021 must be requested from WellCare South Carolina. WellCare of South Carolina will be known as Absolute Total Care as of April 1, 2021. Welcome to WellCare Provider Login Contact Us Join Our Network Medicaid Medicare Tools News and Education AcariaHealth Specialty Pharmacy Pharmacy Forms Request for Drug Coverage Request to Review Drug Coverage Denial . Please use the From Date Institutional Statement Date. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. Copyright 2023 Wellcare Health Plans, Inc. 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 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. 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. 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.