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. Your second-level review will be performed by person(s) not involved in the first review. A. 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. 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. DOSApril 1, 2021 and after: Processed by Absolute Total Care. L]4(f4/pn~YTZSp-5/O*F)e~p:a6o{x8r You will have a limited time to submit additional information for a fast appeal. P.O. A. \{-w{,xI202100$0*bZf ,X AayhP3pYla" e 3G& `eoT#@ *;d
Claims Department Q. Send your written appeal to: We must have your written consent before someone can file an appeal for you. WellCare Medicare members are not affected by this change. If you think you might have been exposed, contact a doctor immediately. A. A. More Information Coronavirus (COVID-19) Claims for services on or after April 1, 2021 should be filed to Absolute Total Care for processing. As of April 1, 2021, all WellCare of South Carolina Medicaid members will become Absolute Total Care members. Finding a doctor is quick and easy. WellCare of South Carolina will be known as Absolute Total Care as of April 1, 2021. 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. Here you will find the tools and resources you need to help manage your submission of claims and receipt of payments. Wfu neebybfgnh bgWfulnybfgC South Carolina Medicaid Provider Resource Guide Thank you for being a star member of our provider team. Refer to your particular provider type program chapter for clarification. However, there will be no members accessing/assigned to the Medicaid portion of the agreement. If at any time you need help filing one, call us. Absolute Total Care will honor those authorizations. With the completion of this transaction, we have created a premier healthcare enterprise focused on government-sponsored healthcare programs. Contact Us Y0020_WCM_100876E Last Updated On: 10/1/2022 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. Providers can help facilitate timely claim payment by having an understanding of our processes and requirements. WellCare Health Plans, Inc. (NYSE: WCG) is now offering a $120 credit per family, per year towards over-the-counter (OTC) items as part of its Medicaid program benefits in South Carolina. Earliest From Dates on or after April 1, 2021 should be filed to Absolute Total Care. 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. 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. We will send you another letter with our decision within 90 days or sooner. For general questions about claims submissions, call Provider Claims Services at 1-800-575-0418. From Date Institutional Statement Dates on or after 4/1/2021 should be filed to Absolute Total Care. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. You may request a State Fair Hearing at this address: South Carolina Department of Health The timely filing limit is the time duration from service rendered to patients and submitting claims to the insurance companies. What is the Rx BIN and Group Number for WellCare members transitioning to Absolute Total Care on April 1, 2021? Additionally, WellCare will have a migration section on their provider page at publishing FAQs. To continue care with their current provider after the 90-day transition of care, the provider must agree to work with Absolute Total Care on the member's care and accept Absolute Total Care's payment rates. We are committed to improving the quality of life of our millions of members, who often include some of our nations most vulnerable populations. It will tell you we received your grievance. We are glad you joined our family! State Health Plan State Claims P.O. The way your providers or others act or treat you. We will also send you a letter with our decision within 72 hours from receiving your appeal. A grievance is when you tell us about a concern you have with our plan. Example of how to properly split claim that span the cutover date of 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. If Statement Range is March 14, 2021 through April 3, 2021, please send to WellCare. Know the facts about Coronavirus (COVID-19) Our call centers, including the nurse advice line, are currently experiencing high volume. You can file your appeal by calling or writing to us. Claims will be processed according to timely filing provisions in the providers WellCare Participating Provider Agreement. 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 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. Q. They are called: State law allows you to make a grievance if you have any problems with us. With quality healthcare solutions, Ambetter from Absolute Total Care helps residents of South Carolina live better. 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. WellCare of South Carolina will be known as Absolute Total Care as of April 1, 2021. Obstetrician care provided by an out-of-network obstetrician will be covered for pregnant members inclusive of postpartum care. WellCare Medicaid members migrating to Absolute Total Care will be assigned to their assigned WellCare primary care provider as if the primary care provideris in network with Absolute Total Care. Will Absolute Total Care change its name to WellCare? You may do this in writing or in person. However, there will be no members accessing/assigned to the Medicaid portion of the agreement. All billing requirements must be adher ed to by the provider in order to ensure timely processing of claims. Providers interested in joining the Absolute Total Care Provider Network should submit a request to Network Development and Contracting via email at. 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. Provider can't require members to appoint them as a condition of getting services. 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. To write us, send mail to: You can fax it too. you have another option. The participating provider agreement with WellCare will remain in-place after April 1, 2021. We are simplifying Medicare so you can choose and use an affordable local plan that will help you achieve your best possible health. Farmington, MO 63640-3821. 1,flQ*!WLOmsmz\D;I5BI,yA#z!vYQi5'fedREF40
b666q1(UtUJJ.i` (T/@E This includes providing assistance with accessing interpreter services and hearing impaired . Box 8206 Columbia, SC 29202-8206 Or call 1-800-763-9087. 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. It is 30 days to 1 year and more and depends on . Exceptions to the one-year time limit: a) Medicare Cost Sharing Claims . 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. From Date Institutional Statement Dates on or after April 1, 2021 should be filed to Absolute Total Care. Get an annual flu shot today. Absolute Total Care will honor all existing WellCare authorization approvals that include dates of service beyond March 31, 2021. 8h} \x p`03
1z`@+`~70 G ~Ws5Puick79,4 ,O5@?O-Gr'|5Oj:v6/` The hearing officer does not decide in your favor. Q. To continue care with their current provider after the 90-day Transition of Care, the provider must agree to work with Absolute Total Care on the member's care and accept Absolute Total Care's payment rates. Q. You can also have a video visit with a doctor using your phone or computer. Wellcare uses cookies. You or your authorized representative can review the information we used to make our decision. Payments mailed to providers are subject to USPS mailing timeframes. An authorized representative is someone you select to act on the behalf of a member to assist them through the appeals process. Initial Claims: 120 Days from the Date of Service. To avoid rejections please split the services into two separate claim submissions. Member Sign-In. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. PROVIDERS NOTE:Please send Corrected Claims as normal submissions via electronic or paper. Claims Department 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. 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. You or your provider must call or fax us to ask for a fast appeal.