You will receive an acknowledgement letter within 5 business days, and we will send you a resolution within 90 calendar days. Copyright 2023 Wellcare Health Plans, Inc. Download the free version of Adobe Reader. 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. Wellcare uses cookies. Timely Filing Beginning October 1, 2020, the Timely Filing submission requirements specified in each Provider's Meridian Medicare contract will be enforced. As of April 1, 2021, all WellCare of South Carolina Medicaid members will become Absolute Total Care members. Date of Occurrence/DOSApril 1, 2021 and after: Processed by Absolute Total Care. Members can continue to receive services from their current WellCare provider as long as they remain covered under WellCare. Explains rules and state, line of business and CMS-specific regulations regarding 837I EDI transactions. 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. PROVIDERS NOTE:Please send Corrected Claims as normal submissions via electronic or paper. From Date Institutional Statement Dates on or after April 1, 2021 should be filed to Absolute Total Care. We cannot disenroll you from our plan or treat you differently. We expect this process to be seamless for our valued members and there will be no break in their coverage. Please be sure to use the correct line of business prior authorization form for prior authorization requests. WellCare and Absolute Total Care Medicare plans will continue to operate under current brands, product names and provider contracts, until further notice. 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. We must have your written permission before someone can file a grievance for you. However, as of April 1, 2021, all WellCare of South Carolina Medicaid members will become Absolute Total Care members. The second level review will follow the same process and procedure outlined for the initial review. Farmington, MO 63640-3821. Copyright 2023 WellCare Health Plans, Inc. WellCare Non-Emergency Medical Transportation (NEMT) Update, Provider Self-Service Quick Reference Guide (PDF), Provider Masters Level Proposed Rates (PDF), Member Advisory Committee (MAC) Member Flyer (PDF), Member Advisory Committee (MAC) - LTSS Member Flyer (PDF), Managed Care PHP Member PCP Change Request Form (PDF), Provider Referral Form: LTSS Request for PCS Assessment (PDF). Attn: Grievance Department Finding a doctor is quick and easy. How will credentialing/recredentialing be handled by Absolute Total Care if a provider was recently credentialed/recredentialed by WellCare? 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. 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. $8v + Yu @bAD`K@8m.`:DPeV @l All billing requirements must be adher ed to by the provider in order to ensure timely processing of claims. To do this: Be sure to ask us to continue your benefits within the 10 calendar day time frame. WellCare Medicare members are not affected by this change. Members will need to talk to their provider right away if they want to keep seeing him/her. 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 expect this process to be seamless for our valued members, and there will be no break in their coverage. 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. They are called: State law allows you to make a grievance if you have any problems with us. PDF All Medicaid Bulletin - Sc Dhhs Outpatient Prior Authorization Form (PDF) Inpatient Prior Authorization Form (PDF) 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. The participating provider agreement with WellCare will remain in-place after 4/1/2021. A. Payments mailed to providers are subject to USPS mailing timeframes. Q. Q. What is UnitedHealthcare timely filing limit? - Sage-Answer 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. It is 30 days to 1 year and more and depends on . Claims Department Box 8206 How do I join Absolute Total Cares provider network? Initial Claims: 120 Days from the Date of Service. WellCare of South Carolina will be known as Absolute Total Care as of April 1, 2021. You may file your second level grievance review within 30 days of receiving your grievance decision letter. Providers can help facilitate timely claim payment by having an understanding of our processes and requirements. How do I determine if a professional or an outpatient bill type institutional submission should be filed to WellCare or Absolute Total Care? If you are unable to view PDFs, please download Adobe Reader. With the completion of this transaction, we have created a premier healthcare enterprise focused on government-sponsored healthcare programs. Code of Laws - Title 42 - South Carolina General Assembly Q. However, as of April 1, 2021, all WellCare of South Carolina Medicaid members will become Absolute Total Care members. All dates of service on or after April 1, 2021 should be filed to Absolute Total Care. 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. For current information, visit the Absolute Total Care website. South Carolina : Login Learn how you can help keep yourself and others healthy. 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. To write us, send mail to: You can fax it too. Timely Filing: A Cheat Sheet for PTs | WebPT Wellcare uses cookies. Q. For general questions about claims submissions, call Provider Claims Services at 1-800-575-0418. Login - WellCare Q. 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. Wfu neebybfgnh bgWfulnybfgC South Carolina Medicaid Provider Resource Guide Thank you for being a star member of our provider team. Explains how to receive, load and send 834 EDI files for member information. Box 31224 However, there will be no members accessing/assigned to the Medicaid portion of the agreement. Register now at https://www.payspanhealth.comor contact PaySpan at providersupport@payspanhealth.com, or 877-331-7154. P.O. Molina Healthcare of Michigan, 100 W. Big Beaver Road, Suite 600 Attn: Claims, Troy, MI 48084-5209 Or Fax to: (248) 925-1768. #~0 I 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. WellCare is the health care plan that puts you in control. We want to ensure that claims are handled as efficiently as possible. Explains rules and state, line of business and CMS-specific regulations regarding 837I EDI transactions. Claims submission, correspondence, and contact resources will stay the same for the Medicare line of business. Claims Guides | BlueCross BlueShield of South Carolina Earliest From Dates prior to 4/1/2021 should be filed to WellCare of South Carolina. Written notice is not needed if your expedited appeal request is filed verbally. South Carolina Medicaid Provider Resource Guide - WellCare 1,flQ*!WLOmsmz\D;I5BI,yA#z!vYQi5'fedREF40 b666q1(UtUJJ.i` (T/@E A. Claims for services on or after April 1, 2021 should be filed to Absolute Total Care for processing. WellCare of South Carolina will be known as Absolute Total Care as of April 1, 2021. Wellcare uses cookies. Federal Employee Program (FEP) Federal Employee Program P.O. Claims | Wellcare 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 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. Copyright 2023 Wellcare Health Plans, Inc. Clinical Laboratory Improvement Amendments (CLIA). Explains rules and state, line of business and CMS-specific regulations regarding 837P EDI transactions. \{-w{,xI202100$0*bZf ,X AayhP3pYla" e 3G& `eoT#@ *;d Within five business days of getting your grievance, we will mail you a letter. 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. z4M0(th`1Lf`M18c BIcJ[%4l JU2 _ s If you need claim filing assistance, please contact your provider advocate. We will notify you orally and in writing. 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. Claims Submission | BlueCross BlueShield of South Carolina