Instructions on how to submit a corrected or voided claim. Providers can help facilitate timely claim payment by having an understanding of our processes and requirements. You can file a grievance by calling or writing to us.
Q. We are simplifying Medicare so you can choose and use an affordable local plan that will help you achieve your best possible health. 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. Download the free version of Adobe Reader. We are proud to announce that WellCare is now part of the Centene Family. Download the free version of Adobe Reader. Refer to your particular provider type program chapter for clarification. 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. APPEALS, GRIEVANCES AND PROVIDER DISPUTES. You will need Adobe Reader to open PDFs on this site. People of all ages can be infected. 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. Claims for services on or after April 1, 2021 should be filed to Absolute Total Care for processing. You, your friend, a relative, legal counsel or other spokesperson who has your written consent may ask for a State Fair Hearing. To continue providing transition of care services, providers that are not part of the Absolute Total Care Network must agree to work with Absolute Total Care and accept Absolute Total Cares payment rates. 1044 0 obj
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Please use the From Date Institutional Statement Date. You can make three types of grievances. WellCare claims will be processed according to timely filing provisions in the providers WellCare Participating Provider Agreement. We try to make filing claims with us as easy as possible. Providers interested in joining the Absolute Total Care Provider Network should submit a request to Network Development and Contracting via email at. We are proud to announce that WellCare is now part of the Centene Family. 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. Send your written appeal to: We must have your written consent before someone can file an appeal for you. What is the Rx BIN and Group Number for WellCare members transitioning to Absolute Total Care on April 1, 2021? It can also be about a provider and/or a service. Members must have Medicaid to enroll. Please use the From Date Institutional Statement Date. Contact Wellcare Prime Provider Service at 1-855-735-4398 if you have questions. Q. Learn how you can help keep yourself and others healthy. Earliest From Dates prior to April 1, 2021 should be filed to WellCare of South Carolina. WellCare and Absolute Total Care Medicare plans will continue to operate under current brands, product names and provider contracts, until further notice. You may do this in writing or in person. A provider can act for a member in hearings with the member's written permission in advance. 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. Federal Employee Program (FEP) Federal Employee Program P.O. If Statement Range is April 2, 2021 through April 10, 2021, please send to Absolute Total Care. Claims will be processed according to timely filing provisions in the providers WellCare Participating Provider Agreement. This person has all beneficiary rights and responsibilities during the appeal process. Explains how to receive, load and send 834 EDI files for member information. This includes providing assistance with accessing interpreter services and hearing impaired . You can get many of your Coronavirus-related questions answered here. 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. Call us to get this form. Please see list of services that will require authorization during this time. 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). It was a smart move. 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. 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 . To do this: Claims will be processed according to timely filing provisions in the providers Absolute Total Care Participating Provider Agreement. State Health Plan State Claims P.O. A. The annual flu vaccine helps prevent the flu. With the completion of this transaction, we have created a premier healthcare enterprise focused on government-sponsored healthcare programs. We must have your written permission before someone can file a grievance for you. However, there will be no members accessing/assigned to the Medicaid portion of the agreement. Utilize interactive health and wellness tools to help you manage conditions, improve your health and save money. WellCare of South Carolina will be known as Absolute Total Care as of April 1, 2021. and Human Services Those who attend the hearing include: You can also request to have your hearing over the phone. Explains rules and state, line of business and CMS-specific regulations regarding 837P EDI transactions. Explains rules and state, line of business and CMS-specific regulations regarding 837I EDI transactions. A grievance is when you tell us about a concern you have with our plan. Q. %%EOF
Box 8206 If you need claim filing assistance, please contact your provider advocate. Wellcare uses cookies. All dates of service prior to April 1, 2021 should be filed to WellCare of South Carolina. Exceptions to the one-year time limit: a) Medicare Cost Sharing Claims . 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. The timely filing limit is the time duration from service rendered to patients and submitting claims to the insurance companies. North Carolina PHP Billing Guidance for Local W Code. 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. South Carolina | Wellcare SOUTH CAROLINA Healthcare done well. Earliest From Dates on or after 4/1/2021 should be filed to Absolute Total Care. Contact Us Y0020_WCM_100876E Last Updated On: 10/1/2022 you have another option. hYnH~}9'I`@>cLq,&DYH"W~&eJx'"luWU]JDBFRJ!*SN(s'6# ^*dg4$SB7K4z:r6')baka+Raf4J=)l,
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Q. From Date Institutional Statement Dates prior to 4/1/2021 should be filed to WellCare of South Carolina. P.O. To have someone represent you, you must complete an Appointment of Representative (AOR) form. A. Get an annual flu shot today. Will Absolute Total Care change its name to WellCare? Members can continue to receive services from their current WellCare provider as long as they remain covered under WellCare. Q: What is Absolute Total Cares Transition/Continuity of Care Policy? March 14-March 31, 2021, please send to WellCare. You can file your appeal by calling or writing to us. Incorrect forms will not be considered and may lead to further delays in processing prior authorization requests. The participating provider agreement with WellCare will remain in-place after April 1, 2021. Providers can begin requesting prior authorization for pharmacy services from Absolute Total Care for dates of service on or after April 1, 2021 from Absolute Total Care on April 1, 2021. The hearing officer does not decide in your favor. We expect this process to be seamless for our valued members and there will be no break in their coverage. South Carolina Department of Health and Human Services Division of Appeals and Hearings P.O. Reminder: It is important that providers check eligibility prior to providing services as members can potentially change plans prior to April 1, 2021 if they are in the annual choice period.