The second level review will follow the same process and procedure outlined for the initial review. Providers interested in joining the Absolute Total Care vision network for routine vision services can contact Envolve Vision at 1-800-531-2818. You may request a State Fair Hearing at this address: South Carolina Department of Health Absolute Total Care However, as of April 1, 2021, all WellCare of South Carolina Medicaid members will become Absolute Total Care members. 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. This must be done within 120 days from the date of Notice of Appeal Resolution you received from us. Learn more about how were supporting members and providers. Resources Box 8206 Columbia, SC 29202-8206 Or call 1-800-763-9087. What is the Rx BIN and Group Number for WellCare members transitioning to Absolute Total Care on April 1, 2021? Your second-level review will be performed by person(s) not involved in the first review. Explains rules and state, line of business and CMS-specific regulations regarding 837P EDI transactions. Download the free version of Adobe Reader. Claims for services on or after April 1, 2021 should be filed to Absolute Total Care for processing. You can file your appeal by calling or writing to us. Box 600601 Columbia, SC 29260. 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 of South Carolinawants to ensure that claims are handled as efficiently as possible. 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. 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, 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. It was a smart move. If at any time you need help filing one, call us. Reconsideration or Claim Disputes/Appeals: 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. The participating provider agreement with WellCare will remain in-place after 4/1/2021. Outpatient Prior Authorization Form (PDF) Inpatient Prior Authorization Form (PDF) WellCare of South Carolina will be known as Absolute Total Care as of April 1, 2021. A hearing officer from the State will decide if we made the right decision. Claims submission, correspondence, and contact resources will stay the same for the Medicare line of business. Our fax number is 1-866-201-0657. How do I bill a professional submission with services spanning before and after 04/01/2021? Register now at https://www.payspanhealth.comor contact PaySpan at providersupport@payspanhealth.com, or 877-331-7154. WellCare of South Carolina will be known as Absolute Total Care as of April 1, 2021. You will have a limited time to submit additional information for a fast appeal. Instructions on how to submit a corrected or voided claim. 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. We will send you another letter with our decision within 90 days or sooner. How do I determine if an institutional inpatient bill type submission overlapping 4/1/2021 should be filed to WellCare or Absolute Total Care? 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. You can make three types of grievances. No, Absolute Total Care will continue to operate under the Absolute Total Care name. Member Sign-In. Keep yourself informed about Coronavirus (COVID-19.) The way your providers or others act or treat you. WellCare Medicare members are not affected by this change. 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. If you think you might have been exposed, contact a doctor immediately. #~0 I WellCare and Absolute Total Care Medicare plans will continue to operate under current brands, product names and provider contracts, until further notice. B^E{h#XYQv;[ny3Hha1yx4v.sBy jWacQzyL.kHhwtQ~35!Rh#)p+sj31LcC)4*Z:IWIG@WTD- )n,! You or your provider must call or fax us to ask for a fast appeal. Additionally, WellCare will have a migration section on their provider page at publishing FAQs. Attn: Grievance Department The annual flu vaccine helps prevent the flu.Protect yourself and those around you. This gives members time to establish with a new provider in the network and ensure that they have continuity of 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. We expect this process to be seamless for our valued members, and there will be no break in their coverage. For dates of service on or after April 1, 2021: Absolute Total Care Providers interested in joining the Absolute Total Care vision network for routine vision services can contact Envolve Vision at 1-800-531-2818. This gives members time to establish with a new provider in the network and ensure that they have continuity of care. We are proud to announce that WellCare is now part of the Centene Family. You can do this at any time during your appeal. This manual sets forth the policies and procedures that providers participating in the Wellcare Prime network are required to follow. You will get a letter from us when any of these actions occur. At the hearing, well explain why we made our decision. We will also send you a letter with our decision within 72 hours from receiving your appeal. These SNP plans provide benefits beyond Original Medicare, and may include transportation to medical appointments and vision exams. You now have access to a secure, quick way to electronically settle claims. To do so by phone, call Member Services at 1-888-588-9842 (TTY1-877-247-6272). To write us, send mail to: You can fax it too. State Health Plan State Claims P.O. In South Carolina, WellCare and Absolute Total Care are joining to better serve you. From Date Institutional Statement Dates on or after April 1, 2021 should be filed to Absolute Total Care. Members will need to talk to their provider right away if they want to keep seeing him/her. Addakam ditoy para kenka. 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. Timely Filing Beginning October 1, 2020, the Timely Filing submission requirements specified in each Provider's Meridian Medicare contract will be enforced. 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. Will Absolute Total Care change its name to WellCare? Providers do not need to do anything additional to provide services on or after April 1, 2021 if the provider is in network with both WellCare and Absolute Total Care. With the completion of this transaction, we have created a premier healthcare enterprise focused on government-sponsored healthcare programs. Absolute Total Care will honor those authorizations. WellCare credentialing cycles will be shared with Absolute Total Care in order to reduce duplicative credentialing in the future. Q. We are glad you joined our family! Please use the Earliest From Date. You will need Adobe Reader to open PDFs on this site. Q. Q. Or you can have someone file it for you. You or your authorized representative will tell the hearing officer why you think we made the wrong decision. you have another option. Claims for services prior to April 1, 2021 should be filed to WellCare for processing. With the completion of this transaction, we have created a premier healthcare enterprise focused on government-sponsored healthcare programs. All dates of service prior to April 1, 2021 should be filed to WellCare of South Carolina. More Information Need help? The hearing officer does not decide in your favor. A. The annual flu vaccine helps prevent the flu. Members can continue to receive services from their current WellCare provider as long as they remain covered under WellCare. South Carolina | Wellcare SOUTH CAROLINA Healthcare done well. A. For general questions about claims submissions, call Provider Claims Services at 1-800-575-0418. The provider needs to contact Absolute Total Care to arrange continuing care. Q. We comply with applicable Federal civil rights laws and do not discriminate on the basis of race, color, national origin, age, sex, or disability. 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). For current information, visit the Absolute Total Care website. 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. Wellcare uses cookies. 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. WellCare claims will be processed according to timely filing provisions in the providers WellCare Participating Provider Agreement. Claims will be processed according to timely filing provisions in the providers Absolute Total Care Participating Provider Agreement. 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. 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. A. Wfu neebybfgnh bgWfulnybfgC South Carolina Medicaid Provider Resource Guide Thank you for being a star member of our provider team. Utilize interactive health and wellness tools to help you manage conditions, improve your health and save money. Search for primary care providers, hospitals, pharmacies, and more! 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. 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. Pharmacy services prior to April 1, 2021 must be requested from WellCare of South Carolina. How will credentialing/recredentialing be handled by Absolute Total Care if a provider was recently credentialed/recredentialed by WellCare? Instructions on how to submit a corrected or voided claim. First Choice can accept claim submissions via paper or electronically (EDI). To avoid rejections please split the services into two separate claim submissions. WellCare Medicare Advantage Claims must be filed within 180 calendar days from the date of service. As of April 1, 2021, WellCare will no longer be a separate plan option offered by South Carolina Healthy Connections Choices. 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. 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 Our toll-free fax number is 1-877-297-3112. You will need Adobe Reader to open PDFs on this site. Learn how you can help keep yourself and others healthy. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. Timely filing is when you file a claim within a payer-determined time limit. Payments mailed to providers are subject to USPS mailing timeframes. You can file the grievance yourself. WellCare offers participating providers EFT and ERA services at no charge through PaySpan Health. 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. Claims Department Go365 for Humana Healthy Horizons Members can register for the new Go365 for Humana Healthy Horizons wellness program and earn rewards for participating in healthy activities. WellCare of North Carolina partners with providers to develop and deliver high-quality, cost-effective health care solutions. Or it can be made if we take too long to make a care decision. 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.