To have someone represent you, you must complete an Appointment of Representative (AOR) form. All dates of service prior to April 1, 2021 should be filed to WellCare of South Carolina. Providers interested in joining the Absolute Total Care vision network for routine vision services can contact Envolve Vision at 1-800-531-2818. We process check runs daily, with the exception of Sundays, National Holidays, and the last day of the month. No, Absolute Total Care will continue to operate under the Absolute Total Care name. Professional and Institutional Encounter EDI transactions should be submitted to WellCare of South Carolina Medicaid with Payer ID 59354. Earliest From Dates prior to April 1, 2021 should be filed to WellCare of South Carolina. For standard requests, if you call in your appeal, you must follow up with a written, signed one, within thirty calendar days. You can file your appeal by calling or writing to us. Learn how you can help keep yourself and others healthy. 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). Electronic and Paper Claims Submissions; Institutional Claims/Encounter Guides. However, there will be no members accessing/assigned to the Medicaid portion of the agreement. These materials are for informational purposes only. Section 1: General Information. UnitedHealthcare Dual Complete Special Needs Plan UnitedHealthcare Dual Complete Special Needs Plans (SNP) offer benefits for people with both Medicare and Medicaid. A hearing officer from the State will decide if we made the right decision. 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. pst/!+ Y^Ynwb7tw,eI^ 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. More Information Need help? 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. What is the Rx BIN and Group Number for WellCare members transitioning to Absolute Total Care on April 1, 2021? Please use the Earliest From Date. You must ask within 30 calendar days of getting our decision. Pregnant members receiving care from an out-of-network Obstetrician can continue to see their current obstetrician until after the baby is born. 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. 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? 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. 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. Payments mailed to providers are subject to USPS mailing timeframes. This gives members time to establish with a new provider in the network and ensure that they have continuity of care. You can make three types of grievances. The Claim Reconsideration process is an informal claim review, and is not a substitute for an appeal of a final agency decision. 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. Need an account? WellCare of South Carolina will be known as Absolute Total Care as of April 1, 2021. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. 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. You or your authorized representative will tell the hearing officer why you think we made the wrong decision. 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. Absolute Total Care will honor those authorizations. You will need Adobe Reader to open PDFs on this site. A. Copyright 2023 Wellcare Health Plans, Inc. 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. We have licensed clinicians available to speak with you and to connect you to the support you need to feel better. Box 3050 It is 30 days to 1 year and more and depends on . 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. Explains how to receive, load and send 834 EDI files for member information. Please see list of services that will require authorization during this time. The Medicare portion of the agreement will continue to function in its entirety as applicable. Awagandakami As of April 1, 2021, all WellCare of South Carolina Medicaid members will transfer to Absolute Total Care. From Date Institutional Statement Dates prior to 4/1/2021 should be filed to WellCare of South Carolina. Please use WellCare Payor ID 14163. The participating provider agreement with WellCare will remain in-place after April 1, 2021. Explains how to receive, load and send 834 EDI files for member information. 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. A grievance is when you tell us about a concern you have with our plan. You can also have a video visit with a doctor using your phone or computer. Send your written appeal to: We must have your written consent before someone can file an appeal for you. Select your topic and plan and click "Chat Now!" to chat with a live agent! 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. 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. Will WellCare continue to offer current products or Medicare only? Claims submission, correspondence, and contact resources will stay the same for the Medicare line of business. 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. WellCare and Absolute Total Care Medicare plans will continue to operate under current brands, product names and provider contracts, until further notice. April 1-April 3, 2021, please send to Absolute Total Care. B^E{h#XYQv;[ny3Hha1yx4v.sBy jWacQzyL.kHhwtQ~35!Rh#)p+sj31LcC)4*Z:IWIG@WTD- )n,! The materials located on our website are for dates of service prior to April 1, 2021. Pharmacy services prior to 4/1/2021 must be requested from WellCare South Carolina. Download the free version of Adobe Reader. Pharmacy services prior to April 1, 2021 must be requested from WellCare of South Carolina. Beginning. Written notice is not needed if your expedited appeal request is filed verbally. If you dont, we will have to deny your request. WellCare claims will be processed according to timely filing provisions in the providers WellCare Participating Provider Agreement. 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 April 1, 2021 should be filed to Absolute Total Care. If Statement Range is April 2, 2021 through April 10, 2021, please send to Absolute Total Care. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. $8v + Yu @bAD`K@8m.`:DPeV @l 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. 1096 0 obj <>stream 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. Our fax number is 1-866-201-0657. Here are some guides we created to help you with claims filing. 837 Institutional Encounter 5010v Guide 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. Finding a doctor is quick and easy. 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. We may apply a 14 day extension to your grievance resolution. Claim Filing AmeriHealth Caritas North Carolina, hereafter referred to as the Plan (where appropriate), is required by the North Carolina and federal regulations to capture specific data regarding services rendered to its members. A. 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. It will tell you we received your grievance. We understand that maintaining a healthy community starts with providing care to those who need it most. 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. 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. As of April 1, 2021, all WellCare of South Carolina Medicaid members will become Absolute Total Care members. A. Copyright 2023 Wellcare Health Plans, Inc. Clinical Laboratory Improvement Amendments (CLIA). 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. You will receive an acknowledgement letter within 5 business days, and we will send you a resolution within 90 calendar days. 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 Medicaid Claims Payment Policies Date of Occurrence/DOSApril 1, 2021 and after: Processed by Absolute Total Care. * Password. 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. 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. 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. 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. It is called a "Notice of Adverse Benefit Determination" or "NABD." Ancillary Claims Filing Reminders; ClaimsXten TM: Correct Coding Initiative Reference Guide; Inpatient Non-Reimbursable Charges/Unbundling Policy Download the free version of Adobe Reader. Q. Your second-level review will be performed by person(s) not involved in the first review. Providers can help facilitate timely claim payment by having an understanding of our processes and requirements. Q. Select Health Claims must be filed within 12 months from the date of service. All Paper Claim Submissions can be mailed to: WellCare Health Plans Tampa, FL 33631-3384. We cannot disenroll you from our plan or treat you differently. Q. Where should I submit claims for WellCare Medicaid members that transition to Absolute Total Care?
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