Our fax number is 1-866-201-0657. With the completion of this transaction, we have created a premier healthcare enterprise focused on government-sponsored healthcare programs. Claims and billing - Select Health of SC 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 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 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. South Carolina Medicaid & Health Insurance | Absolute Total Care Authorizations already processed by WellCare for any services on or after April 1, 2021, will be moved to Absolute Total Care and there is no need for the provider or member to request these services again. 2) Reconsideration or Claim disputes/Appeals. Q. 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. This manual sets forth the policies and procedures that providers participating in the Wellcare Prime network are required to follow. Search for primary care providers, hospitals, pharmacies, and more! 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, Shortened Notification of Pregnancy (NOP) Provider Form (PDF), Notification of Pregnancy (NOP) Provider Form (PDF), Pregnancy Incentive Reimbursement Form (PDF), SCDHHS Form 1716 - Request for Medicaid ID Number - Infant (PDF), Member Appointment of Authorized Representative Form (PDF), SCDHHS Hospice Election/Enrollment Forms (PDF), Inpatient Prior Authorization Fax Form (PDF), Outpatient Prior Authorization Fax Form (PDF), SCDHHS Certificate of Medical Necessity (CMN) for Oxygen (PDF), Sick and Well Visit Reimbursement Letter (PDF), Claim Adjustments, Reconsiderations, and Disputes Provider Education (PDF), Obstetrical (OB) Incentive Programs (PDF), Provider Portal Enhancements: Claim Reconsideration and Denial Explanations (PDF), Outpatient Prior Authorization Form (PDF), Medicare Prescription Drug Coverage Determination Form (PDF), Authorization to Use and/or Disclose Health Information (PDF), Revocation of Authorization to Use and/or Disclose Health Information (PDF), Behavioral Health Psychological or Neuropsychological Testing Authorization Request Form (PDF), Electroconvulsive Therapy (ECT) Authorization Request Form (PDF), Behavioral Health Outpatient Treatment Request Form (PDF), Transitional Care Management Services Fact Sheet (PDF), Expedited Prior Authorization Request FAQ (PDF), Balance Billing Quick Reference Guide (PDF), 2021 Prior Authorization List Part B Appendix A (PDF), Bi-Annual Prior Authorization Update (PDF), 2021 Bi-Annual Prior Authorization Update Effective 8/1/21 (PDF), 2021 List of Covered Drugs (Formulary) Changes (PDF), New Century Health Implementation Notification (PDF), 2022 Wellcare by Allwell Provider Manual (PDF), Provider Reconsideration/Dispute Form (PDF), Behavioral Health Neuropsychological Testing Authorization Request Form (PDF), Behavioral Health Outpatient Treatement Request Form (PDF), Behavioral Health Electroconvulsive Therapy (ECT) Authorization Request Form (PDF), Electronic Funds Transfer (ETF) Features (PDF), 2021 List of Covered Drugs (Formulary) DSNP Changes (PDF), 2021 List of Covered Drugs (Formulary) HMO Changes (PDF). 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. From Date Institutional Statement Dates prior to April 1, 2021 should be filed to WellCare of South Carolina. WellCare claims will be processed according to timely filing provisions in the providers WellCare Participating Provider Agreement. Timely filing is when you file a claim within a payer-determined time limit. Box 8206 DOS prior toApril 1, 2021: Processed by WellCare. You will need Adobe Reader to open PDFs on this site. Claims - Wellcare NC You must file your appeal within 60 calendar days from the date on the NABD. Additionally, WellCare will have a migration section on their provider page at publishing FAQs. Timely filing limits vary. P.O. We welcome Brokers who share our commitment to compliance and member satisfaction. WellCare claims will be processed according to timely filing provisions in the providers WellCare Participating Provider Agreement. Our toll-free fax number is 1-877-297-3112. Overview & Resources WellCare of North Carolina partners with providers to develop and deliver high-quality, cost-effective health care solutions. hbbd``b`$= $ You can file the grievance yourself. Earliest From Dates prior to April 1, 2021 should be filed to WellCare of South Carolina. Wellcare uses cookies. 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. 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. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. 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. Member Sign-In. We will review it and send you a decision letter within 30 calendar days from receiving your appeal. As of April 1, 2021, all WellCare of South Carolina Medicaid members will transfer to Absolute Total Care. PROVIDERS NOTE:Please send Corrected Claims as normal submissions via electronic or paper. 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. South Carolina Medicaid Provider Documents - Humana The participating provider agreement with WellCare will remain in-place after 4/1/2021. As of April 1, 2021, WellCare will no longer be a separate plan option offered by South Carolina Healthy Connections Choices. Register now at https://www.payspanhealth.comor contact PaySpan at providersupport@payspanhealth.com, or 877-331-7154. North Carolina PHP Billing Guidance for Local W Code. A. In South Carolina, WellCare and Absolute Total Care are joining to better serve you. Providers are encouraged to visit the Provider Resources webpagefor manuals, forms, and resources related to claims submission, eligibility, prior authorization, and more. You or your authorized representative can review the information we used to make our decision. A. WellCare credentialing cycles will be shared with Absolute Total Care in order to reduce duplicative credentialing in the future. Claims submission, correspondence, and contact resources will stay the same for the Medicare line of business. Wellcare uses cookies. Farmington, MO 63640-3821. P.O. South Carolina | Wellcare Members will receive a 90-day transition of care period if the member is receiving ongoing care and treatment. the timely filing limits due to the provider being unaware of a beneficiary's coverage. South Carolina | Medicaid Please use WellCare Payor ID 14163. You can do this at any time during your appeal. P.O. Providers interested in joining the Absolute Total Care vision network for routine vision services can contact Envolve Vision at 1-800-531-2818. Pregnant members receiving care from an out of network Obstetrician can continue to see their current Obstetrician until after the baby is born. The second level review will follow the same process and procedure outlined for the initial review. Wellcare wants to ensure that claims are handled as efficiently as possible. Please see list of services that will require authorization during this time. (This includes your PCP or another provider.) Claims for services on or after April 1, 2021 should be filed to Absolute Total Care for processing. Download the free version of Adobe Reader. Obstetrician care provided by an out of network Obstetrician will be covered for pregnant members inclusive of post-partum care. 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. 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. %PDF-1.6 % You will get a letter from us when any of these actions occur. you have another option. 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. Q. BlueCross BlueShield of South Carolina Piedmont Service Center P.O. Written notice is not needed if your expedited appeal request is filed verbally. Pharmacy services prior to April 1, 2021 must be requested from WellCare of South Carolina. To do this: 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. Beginning. We expect this process to be seamless for our valued members and there will be no break in their coverage. Providers are encouraged to sign up to receive EFT payments to avoid any payment delays. Claim Reconsideration Policy-Fee For Service (FFS) Medicaid More Information Coronavirus (COVID-19) You can ask for a State Fair Hearing after we make our appeal decision. Claims Submission, Correspondence and Contact Resources will stay the same for the Medicare line of business. Q. Check out the Interoperability Page to learn more. 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. South Carolina Medicaid Provider Resource Guide - WellCare With the completion of this transaction, we have created a premier healthcare enterprise focused on government-sponsored healthcare programs. 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. 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 manual sets forth the policies and procedures that providers participating in the Absolute Total Carenetwork are required tofollow. Claims for services on or after April 1, 2021 should be filed to Absolute Total Care for processing. You will receive an acknowledgement letter within 5 business days, and we will send you a resolution within 90 calendar days. Please be sure to use the correct line of business prior authorization form for prior authorization requests. The participating provider agreement with WellCare will remain in-place after April 1, 2021. 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 may do this in writing or in person. The Claim Reconsideration process is an informal claim review, and is not a substitute for an appeal of a final agency decision. Download the free version of Adobe Reader. You can file an appeal if you do not agree with our decision. 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. What is Molina Healthcare timely filing limit? - Short-Question The provider needs to contact Absolute Total Care to arrange continuing care. 837 Institutional Encounter 5010v Guide English - Wellcare NC Timely Filing Beginning October 1, 2020, the Timely Filing submission requirements specified in each Provider's Meridian Medicare contract will be enforced. 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. 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. hb```b``6``e`~ "@1V NB, If you file a grievance or an appeal, we must be fair. Division of Appeals and Hearings The hearing officer does not decide in your favor. Get an annual flu shot today. We will call you with our decision if we decide you need a fast appeal. To do so by phone, call Member Services at 1-888-588-9842 (TTY1-877-247-6272). Q. Resources Ambetter Timely Filing Limit of : 1) Initial Claims. P.O. Columbia, SC 29202-8206. You, your friend, a relative, legal counsel or other spokesperson who has your written consent may ask for a State Fair Hearing. Absolute Total Care will honor those authorizations. A. Please contact our Provider Services Call Center at 1-888-898-7969. 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 . Forgot Your Password? Q. From Date Institutional Statement Dates on or after April 1, 2021 should be filed to 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 atc_contracting@centene.com. WellCare and Absolute Total Care Medicare plans will continue to operate under current brands, product names and provider contracts, until further notice. DOS April 1, 2021 and after: Processed by Absolute Total Care. How do I determine if a professional or an outpatient bill type institutional submission should be filed to WellCare or Absolute Total Care? 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 Within five business days of getting your grievance, we will mail you a letter. 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. 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. Claims Submission | BlueCross BlueShield of South Carolina You or your provider must call or fax us to ask for a fast appeal. 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. Register now at https://www.payspanhealth.com or contact PaySpan at providersupport@payspanhealth.com, or 877-331-7154. As of April 1, 2021, WellCare will no longer be a separate plan option offered by South Carolina Healthy Connections Choices. We expect this process to be seamless for our valued members, and there will be no break in their coverage. 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. This person has all beneficiary rights and responsibilities during the appeal process. 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. Member Appeals (Medical, Behavioral Health, and Pharmacy): Copyright 2023 Wellcare Health Plans, Inc. As of April 1, 2021, all WellCare of South Carolina Medicaid members will become Absolute Total Care members. Please Explore the Site and Get To Know Us. 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. 8h} \x p`03 1z`@+`~70 G ~Ws5Puick79,4 ,O5@?O-Gr'|5Oj:v6/` A. 2023 Medicare and PDP Compare Plans and Enroll Now. How do I join Absolute Total Cares provider network? Please use the Earliest From Date. The onlineProvider Manual represents the most up-to-date information on Absolute Total Cares Medicaid Plan, programs, policies, and procedures. Date of Occurrence/DOSprior toApril 1, 2021: Processed by WellCare. 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. Claims | Wellcare

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