wellcare of south carolina timely filing limit wellcare of south carolina timely filing limit

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. We welcome Brokers who share our commitment to compliance and member satisfaction. We will notify you orally and in writing. A. A. Claims Department Your second-level review will be performed by person(s) not involved in the first review. Instructions on how to submit a corrected or voided claim. Timely filing is when you file a claim within a payer-determined time limit. Box 8206 Columbia, SC 29202-8206 Or call 1-800-763-9087. 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. Explains rules and state, line of business and CMS-specific regulations regarding 837P EDI transactions. Those who attend the hearing include: You can also request to have your hearing over the phone. Want to receive your payments faster to improve cash flow? You may file your second level grievance review within 30 days of receiving your grievance decision letter. If you request a hearing, the request must: A State Fair Hearing is a legal proceeding. A. Members will need to talk to their provider right away if they want to keep seeing him/her. The Medicare portion of the agreement will continue to function in its entirety as applicable. WellCare understands that having access to the right tools can help you and your staff streamline day-to-day administrative tasks. Hearings are used when you were denied a service or only part of the service was approved. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. 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. Finding a doctor is quick and easy. The Claim Reconsideration process is an informal claim review, and is not a substitute for an appeal of a final agency decision. Q. Welcome to WellCare Provider Login Contact Us Join Our Network Medicaid Medicare Tools News and Education AcariaHealth Specialty Pharmacy Pharmacy Forms Request for Drug Coverage Request to Review Drug Coverage Denial . Will Absolute Total Care continue to offer Medicare and Marketplace products? 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. 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. A. WellCare claims will be processed according to timely filing provisions in the providers WellCare Participating Provider Agreement. 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 can ask in writing for a State Fair Hearing (hearing, for short). Know the facts about Coronavirus (COVID-19) Our call centers, including the nurse advice line, are currently experiencing high volume. Q: What is Absolute Total Cares Transition/Continuity of Care Policy? We may apply a 14 day extension to your grievance resolution. Claims for services on or after April 1, 2021 should be filed to Absolute Total Care for processing. Claim Filing Manual - First Choice by Select Health of South Carolina P.O. Absolute Total Care will honor all existing WellCare authorization approvals that include dates of service beyond March 31, 2021. Q. Thanka kaa yoa Tufrbeau ingsnh ngetfu South Caralaita nouMa mpvd. Explains rules and state, line of business and CMS-specific regulations regarding 837I EDI transactions. How do I join Absolute Total Cares provider network? To do this: Be sure to ask us to continue your benefits within the 10 calendar day time frame. 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! Explains rules and state, line of business and CMS-specific regulations regarding 837I EDI transactions. We will also send you a letter with our decision within 72 hours from receiving your appeal. Guides Filing Claims with WellCare. It will let you know we received your appeal. 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. As of April 1, 2021, all WellCare of South Carolina Medicaid members will transfer to Absolute Total Care. Q. 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. WellCare of South Carolina will be known as Absolute Total Care as of April 1, 2021. %PDF-1.6 % Providers are encouraged to sign up to receive EFT payments to avoid any payment delays. If an authorization is needed, you can log in to the Secure Provider Portal at absolutetotalcare.com to submit and confirm authorizations. Obstetrician care provided by an out-of-network obstetrician will be covered for pregnant members inclusive of postpartum care. We understand that maintaining a healthy community starts with providing care to those who need it most. Q. Providers can help facilitate timely claim payment by having an understanding of our processes and requirements. Medicaid Claims Payment Policies Or it can be made if we take too long to make a care decision. April 1-April 3, 2021, please send to Absolute Total Care. Learn how you can help keep yourself and others healthy. WellCare and Absolute Total Care Medicare plans will continue to operate under current brands, product names and provider contracts, until further notice. Additionally, WellCare will have a migration section on their provider page at publishing FAQs. 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. From Date Institutional Statement Dates on or after April 1, 2021 should be filed to Absolute Total Care. Box 3050 Will Absolute Total Care change its name to WellCare? Claims will be processed according to timely filing provisions in the providers WellCare Participating Provider Agreement. 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. Claims for services on or after April 1, 2021 should be filed to Absolute Total Care for processing. A. WellCare Medicaid members migrating to Absolute Total Care will be assigned to their assigned WellCare Primary Care Physician (PCP) as if the PCP is in network with Absolute Total Care. With the completion of this transaction, we have created a premier healthcare enterprise focused on government-sponsored healthcare programs. The state has also helped to set the rules for making a grievance. Date of Occurrence/DOSApril 1, 2021 and after: Processed by Absolute Total Care. You can get many of your Coronavirus-related questions answered here. Symptoms are flu-like, including: Fever Coughing Effective January 1, 2015 the South Carolina Department of Health and Human Services (SCDHHS) will implement a Claim Reconsideration Policy. Claims will be processed according to timely filing provisions in the providers Absolute Total Care Participating Provider Agreement. An appeal may be filed within 60 calendar days from the date on the Adverse Benefit Determination Notice. endstream endobj startxref Members will receive a 90-day transition of care period if the member is receiving ongoing care and treatment. A. We are proud to announce that WellCare is now part of the Centene Family. If you file a grievance or an appeal, we must be fair. Always verify timely filing requirements with the third party payor. 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. L]4(f4/pn~YTZSp-5/O*F)e~p:a6o{x8r Box 3050 All dates of service prior to April 1, 2021 should be filed to WellCare of South Carolina. DOSApril 1, 2021 and after: Processed by Absolute Total Care. We will continue covering your medical services during your appeal request and State Fair Hearing if all of the following are meet. What will happen to unresolved claims prior to the membership transfer? 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. You, your friend, a relative, legal counsel or other spokesperson who has your written consent may ask for a State Fair Hearing. Beginning, March 14 March 31, 2021, please send to WellCare, April 1 April 3, 2021, please send to Absolute Total Care, DOS prior to 4/1/2021- Processed by WellCare, DOS 4/1/2021 and after- Processed by Absolute Total Care, Date of Occurrence/DOS prior to 4/1/2021- Processed by WellCare, Date of Occurrence/DOS 4/1/2021 and after- Processed by Absolute Total Care. Contact Wellcare Prime Provider Service at 1-855-735-4398 if you have questions. Contact Wellcare Prime Provider Service at1-855-735-4398if youhave questions. hb```b``6``e`~ "@1V NB, Within five business days of getting your grievance, we will mail you a letter. 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. Member Sign-In. 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. 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. Please see list of services that will require authorization during this time. Will WellCare continue to offer current products or Medicare only? Where should I submit claims for WellCare Medicaid members? From Date Institutional Statement Dates on or after 4/1/2021 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. Federal Employee Program (FEP) Federal Employee Program P.O. However, as of April 1, 2021, all WellCare of South Carolina Medicaid members will become Absolute Total Care members. 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. Claims for services prior to April 1, 2021 should be filed to WellCare for processing. 1,flQ*!WLOmsmz\D;I5BI,yA#z!vYQi5'fedREF40 b666q1(UtUJJ.i` (T/@E Q. The onlineProvider Manual represents the most up-to-date information on Wellcare Prime by Absolute Total Care (Medicare-Medicaid Plan), programs, policies, and procedures. Our fax number is 1-866-201-0657. As of April 1, 2021, all WellCare of South Carolina Medicaid members will become Absolute Total Care members. The hearing officer will decide whether our decision was right or wrong. A. On June 19, 2018, the Family and Social Services Administration's ("FSSA") Indiana Health Coverage Programs ("IHCP") released provider bulletin BT201829 regarding revising the timely filing limit for Medicaid fee-for-service claims. Continuation of Benefits During the Appeals Process We will continue covering your medical services during your appeal request and State Fair Hearing if all of the following are meet. To write us, send mail to: You can fax it too. South Carolina | Wellcare SOUTH CAROLINA Healthcare done well. Provider can't require members to appoint them as a condition of getting services. Outpatient Prior Authorization Form (PDF) Inpatient Prior Authorization Form (PDF) PROVIDERS NOTE:Please send Corrected Claims as normal submissions via electronic or paper. 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. If you need assistance with your appeal please call Absolute Total Care at 1-866-433-6041 (TTY: 711) and we will assist you in filing your appeal. Instructions on how to submit a corrected or voided claim. If you are unable to view PDFs, please download Adobe Reader. We are glad you joined our family! 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. 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. Please note - a representative may file for a member who: If the members request for appeal is submitted after 60 calendar days from the date on the NABD, then good cause must be shown in order for WellCare to accept the late request. Explains how to receive, load and send 834 EDI files for member information. A provider can act for a member in hearings with the member's written permission in advance. Our toll-free fax number is 1-877-297-3112. Q. What will happen to my Participating Provider Agreement with WellCare after 4/1/2021? If Statement Range is April 2, 2021 through April 10, 2021, please send to Absolute Total Care. 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. P.O. To earn rewards, members must: Download the Go365 for Humana Healthy Horizons app onto a mobile device from the Apple App Store or Google Play. endstream endobj 1045 0 obj <>/Metadata 50 0 R/OpenAction 1046 0 R/Outlines 160 0 R/Pages 1042 0 R/StructTreeRoot 166 0 R/Type/Catalog/ViewerPreferences<>>> endobj 1046 0 obj <> endobj 1047 0 obj <>/Font<>/ProcSet[/PDF/Text/ImageC/ImageB/ImageI]/XObject<>>>/Rotate 0/StructParents 0/Tabs/S/TrimBox[0.0 0.0 612.0 792.0]/Type/Page>> endobj 1048 0 obj <>stream Box 6000 Greenville, SC 29606. How are WellCare Medicaid member authorizations being handled after April 1, 2021? Claims submission, correspondence, and contact resources will stay the same for the Medicare line of business. Explains rules and state, line of business and CMS-specific regulations regarding 837P EDI transactions. For additional information, questions or concerns, please contact your local Provider Network Management Representative. Members can continue to receive services from their current WellCare provider as long as they remain covered under WellCare. If Statement Range is March 14, 2021 through April 3, 2021, please send to WellCare. 1071 0 obj <>/Filter/FlateDecode/ID[<87133B316ADA4BDD8B85BA48A489D34F>]/Index[1044 53]/Info 1043 0 R/Length 117/Prev 692690/Root 1045 0 R/Size 1097/Type/XRef/W[1 2 1]>>stream 3) Coordination of Benefits. 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 WellCare claims will be processed according to timely filing provisions in the providers WellCare Participating Provider Agreement. WellCare has partnered with Change Healthcare as our preferred EDI Clearinghouse. 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. WellCare of South Carolina will be known as Absolute Total Care as of April 1, 2021. Box 31224 All dates of service on or after 4/1/2021 should be filed to Absolute Total Care. First Choice can accept claim submissions via paper or electronically (EDI). %%EOF Wellcare wants to ensure that claims are handled as efficiently as possible.