Contact Wellcare Prime Provider Service at 1-855-735-4398 if you have questions. the timely filing limits due to the provider being unaware of a beneficiary's coverage. 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. 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. To have someone represent you, you must complete an Appointment of Representative (AOR) form. Providers will follow Absolute Total Care Medicaid policies and procedures for all services, inclusive of medical, behavioral, and pharmaceutical benefits, provided to WellCare Medicaid members transitioning to Absolute Total Care for dates of service on or after April 1, 2021. Absolute Total Care will continue to offer Marketplace products under the Ambetter brand. More Information Coronavirus (COVID-19) This includes providing assistance with accessing interpreter services and hearing impaired . We expect this process to be seamless for our valued members, and there will be no break in their coverage. Example of how to properly split claim that span the cutover date of April 1, 2021: Q. To do this: Be sure to ask us to continue your benefits within the 10 calendar day time frame. For additional information, questions or concerns, please contact your local Provider Network Management Representative. Please use the Earliest From Date. 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. 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. Members will need to talk to their provider right away if they want to keep seeing him/her. Explains how to receive, load and send 834 EDI files for member information. The participating provider agreement with WellCare will remain in-place after 4/1/2021. Wellcare uses cookies. 2) Reconsideration or Claim disputes/Appeals. Claim Filing Manual - First Choice by Select Health of South Carolina Claims for services prior to April 1, 2021 should be filed to WellCare for processing. \{-w{,xI202100$0*bZf ,X AayhP3pYla" e 3G& `eoT#@ *;d
Obstetrician care provided by an out-of-network obstetrician will be covered for pregnant members inclusive of postpartum care. The onlineProvider Manual represents the most up-to-date information on Absolute Total Cares Medicaid Plan, programs, policies, and procedures. 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. P.O. From Date Institutional Statement Dates on or after 4/1/2021 should be filed to Absolute Total Care. Additionally, WellCare will have a migration section on their provider webpage publishing FAQs. 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. WellCare of South Carolina will be known as Absolute Total Care as of April 1, 2021. Absolute Total Care will honor those authorizations. Box 3050 Providers are encouraged to visit the Provider Resources webpagefor manuals, forms, and resources related to claims submission, eligibility, prior authorization, and more. The timely filing limit is the time duration from service rendered to patients and submitting claims to the insurance companies. Providers are encouraged to sign up to receive EFT payments to avoid any payment delays. Resources The way your providers or others act or treat you. Q. Incorrect forms will not be considered and may lead to further delays in processing prior authorization requests. Our toll-free fax number is 1-877-297-3112. Members can continue to receive services from their current WellCare provider as long as they remain covered under WellCare. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. Ambetter Timely Filing Limit of : 1) Initial Claims. WellCare Medicare members are not affected by this change. 2023 Medicare and PDP Compare Plans and Enroll Now. Farmington, MO 63640-3821. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. The Medicare portion of the agreement will continue to function in its entirety as applicable. Copyright 2023 Wellcare Health Plans, Inc. It is called a "Notice of Adverse Benefit Determination" or "NABD." We're here for you. 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. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. The hearing officer does not decide in your favor. 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. Claims Department Select Health Claims must be filed within 12 months from the date of service. To do so by phone, call Member Services at 1-888-588-9842 (TTY1-877-247-6272). Ambetter from Absolute Total Care - South Carolina. 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. We are committed to improving the quality of life of our millions of members, who often include some of our nations most vulnerable populations. The provider needs to contact Absolute Total Care to arrange continuing care. The second level review will follow the same process and procedure outlined for the initial review. They are called: State law allows you to make a grievance if you have any problems with us. This manual sets forth the policies and procedures that providers participating in the Absolute Total Carenetwork are required tofollow. 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 A. Earliest From Dates on or after 4/1/2021 should be filed to Absolute Total Care. We are proud to announce that WellCare is now part of the Centene Family. To do this: All dates of service on or after April 1, 2021 should be filed to Absolute Total Care. Provider can't require members to appoint them as a condition of getting services. Copyright 2023 Wellcare Health Plans, Inc. Q. 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. 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. Our call centers, including the nurse advice line, are currently experiencing high volume. Reconsideration or Claim Disputes/Appeals: You can file your appeal by calling or writing to us. 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! South Carolina | Wellcare SOUTH CAROLINA Healthcare done well. With the completion of this transaction, we have created a premier healthcare enterprise focused on government-sponsored healthcare programs. Box 8206 Here you will find the tools and resources you need to help manage your submission of claims and receipt of payments. To write us, send mail to: You can fax it too. Q. Learn how you can help keep yourself and others healthy. You can get many of your Coronavirus-related questions answered here. With the completion of this transaction, we have created a premier healthcare enterprise focused on government-sponsored healthcare programs. Professional and Institutional Fee-For-Service EDI transactions should be submitted to WellCare of South Carolina Medicaid with Payer ID 14163. More Information Need help? WellCare credentialing cycles will be shared with Absolute Total Care in order to reduce duplicative credentialing in the future. 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. All billing requirements must be adher ed to by the provider in order to ensure timely processing of claims. Please Explore the Site and Get To Know Us. Date of Occurrence/DOSprior toApril 1, 2021: Processed by WellCare. 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. Providers interested in joining the Absolute Total Care vision network for routine vision services can contact Envolve Vision at 1-800-531-2818. Will Absolute Total Care change its name to WellCare? You, your friend, a relative, legal counsel or other spokesperson who has your written consent may ask for a State Fair Hearing. If you dont, we will have to deny your request. A. Contact Us Y0020_WCM_100876E Last Updated On: 10/1/2022 Register now at https://www.payspanhealth.com or contact PaySpan at providersupport@payspanhealth.com, or 877-331-7154. If an authorization is needed, you can log in to the Secure Provider Portal at absolutetotalcare.com to submit and confirm authorizations. You will need Adobe Reader to open PDFs on this site. 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. From Date Institutional Statement Dates prior to 4/1/2021 should be filed to WellCare of South Carolina. It was a smart move. 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. Claims will be processed according to timely filing provisions in the providers Absolute Total Care Participating Provider Agreement. 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. How are WellCare Medicaid member authorizations being handled after April 1, 2021? Download the free version of Adobe Reader. WellCare claims will be processed according to timely filing provisions in the providers WellCare Participating Provider Agreement. For current information, visit the Absolute Total Care website. Will WellCare continue to offer current products or Medicare only? 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. pst/!+ Y^Ynwb7tw,eI^ Contact Wellcare Prime Provider Service at1-855-735-4398if youhave questions. Copyright 2023 Wellcare Health Plans, Inc. For dates of service prior to April 1, 2021: All paper claim submissions can be mailed to: WellCare Health Plans Or you can have someone file it for you. In this section, we will explain how you can tell us about these concerns/grievances. Only you or your authorizedrepresentative can ask for a State Fair Hearing. All dates of service prior to 4/1/2021 should be filed to WellCare of South Carolina. Examples: If Statement Range is March 14, 2021 through April 3, 2021, please send to WellCare. We try to make filing claims with us as easy as possible. Utilize interactive health and wellness tools to help you manage conditions, improve your health and save money. Where should I submit claims for WellCare Medicaid members? Q. A. WellCare of North Carolina partners with providers to develop and deliver high-quality, cost-effective health care solutions.