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. The participating provider agreement with WellCare will remain in-place after April 1, 2021. Providers are encouraged to sign up to receive EFT payments to avoid any payment delays. As of April 1, 2021, all WellCare of South Carolina Medicaid members will transfer to Absolute Total Care. Those who attend the hearing include: You can also request to have your hearing over the phone. 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. With quality healthcare solutions, Ambetter from Absolute Total Care helps residents of South Carolina live better. If you dont, we will have to deny your request. You may request a State Fair Hearing at this address: South Carolina Department of Health Q. If you think you might have been exposed, contact a doctor immediately. Examples of good cause include, but are not limited to, the following: We will send you a letter within five business days of getting your appeal. You or your authorized representative can review the information we used to make our decision. Providers are encouraged to visit the Provider Resources webpagefor manuals, forms, and resources related to claims submission, eligibility, prior authorization, and more. 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 . 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. z4M0(th`1Lf`M18c BIcJ[%4l JU2 _
s WellCare of South Carolina will be known as Absolute Total Care as of April 1, 2021. Send your written appeal to: We must have your written consent before someone can file an appeal for you. Attn: Grievance Department Addakam ditoy para kenka. Learn how you can help keep yourself and others healthy. Please contact our Provider Services Call Center at 1-888-898-7969. You will need Adobe Reader to open PDFs on this site. $8v + Yu @bAD`K@8m.`:DPeV @l Obstetrician care provided by an out of network Obstetrician will be covered for pregnant members inclusive of post-partum care. Absolute Total Care will honor all existing WellCare authorization approvals that include dates of service beyond March 31, 2021. Will Absolute Total Care continue to offer Medicare and Marketplace products? The participating provider agreement with WellCare will remain in-place after 4/1/2021. You must file your appeal within 60 calendar days from the date on the NABD. P.O. You will receive an acknowledgement letter within 5 business days, and we will send you a resolution within 90 calendar days. When you receive your notification of WellCares grievance resolution, and you are dissatisfied with the resolution regarding adverse decisions that affect your ability to receive benefits, access to care, access to services or payment for care of services, you may request a second level review with WellCare. Claims for services prior to April 1, 2021 should be filed to WellCare for processing. Please use the earliest From Date. Members will need to talk to their provider right away if they want to keep seeing him/her. Member Appeals (Medical, Behavioral Health, and Pharmacy): You will need Adobe Reader to open PDFs on this site. If you need claim filing assistance, please contact your provider advocate. 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. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. You or your provider must call or fax us to ask for a fast appeal. WellCare Medicare members are not affected by this change. They must inform their vendor of AmeriHealth Caritas . Claims will be processed according to timely filing provisions in the providers WellCare Participating Provider Agreement. 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. Section 1: General Information. The Medicare portion of the agreement will continue to function in its entirety as applicable. A. Instructions on how to submit a corrected or voided claim. Effective January 1, 2015 the South Carolina Department of Health and Human Services (SCDHHS) will implement a Claim Reconsideration Policy. Claims for services on or after April 1, 2021 should be filed to Absolute Total Care for processing. This includes providing assistance with accessing interpreter services and hearing impaired . 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 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. Welcome to WellCare of South Carolina! Or it can be made if we take too long to make a care decision. Thanka kaa yoa Tufrbeau ingsnh ngetfu South Caralaita nouMa mpvd. You can file the grievance yourself. For additional information, questions or concerns, please contact your local Provider Network Management Representative. A. Farmington, MO 63640-3821. In this section, we will explain how you can tell us about these concerns/grievances. If you dont agree with our appeal decision - and you've completed the appeal steps with our health plan - or, if our appeal decision was not made within the required timeframe (30-calendar days for standard appeals or 72 hours for fast appeals), you may request a State Fair Hearing. Q. N .7$* P!70 *I;Rox3
] LS~. Pregnant members receiving care from an out of network Obstetrician can continue to see their current Obstetrician until after the baby is born. March 14-March 31, 2021, please send to WellCare. Providers interested in joining the Absolute Total Care Provider Network should submit a request to Network Development and Contracting via email at. Please use the Earliest From Date. This person has all beneficiary rights and responsibilities during the appeal process. 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. You can do this at any time during your appeal. Welcome to Wellcare By Allwell, a Medicare Advantage plan. You can file a grievance by calling or writing to us. Box 3050 Pharmacy services prior to April 1, 2021 must be requested from WellCare of South Carolina. Example of how to properly split claim that span the cutover date of April 1, 2021: Q. pst/!+ Y^Ynwb7tw,eI^ Timely filing is when you file a claim within a payer-determined time limit. Q: What is Absolute Total Cares Transition/Continuity of Care Policy? A. Exceptions to the one-year time limit: a) Medicare Cost Sharing Claims . Absolute Total Care will utilize credentialing cycles from WellCare and Absolute Total Care so that providers will only need to credential once every three years. WellCare understands that having access to the right tools can help you and your staff streamline day-to-day administrative tasks. Q. WellCare and Absolute Total Care Medicare plans will continue to operate under current brands, product names and provider contracts, until further notice. This gives members time to establish with a new provider in the network and ensure that they have continuity of care. We must have your written permission before someone can file a grievance for you. Wellcare uses cookies. Resources If an authorization is needed, you can log in to the Secure Provider Portal at absolutetotalcare.com to submit and confirm authorizations. Q. This manual sets forth the policies and procedures that providers participating in the Wellcare Prime network are required to follow. 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. 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. All dates of service on or after April 1, 2021 should be filed to Absolute Total Care. UnitedHealthcare Dual Complete Special Needs Plan UnitedHealthcare Dual Complete Special Needs Plans (SNP) offer benefits for people with both Medicare and Medicaid. Claims Department It is 30 days to 1 year and more and depends on . Q. We will notify you orally and in writing. Earliest From Dates on or after April 1, 2021 should be filed to Absolute Total Care. Professional and Institutional Fee-For-Service EDI transactions should be submitted to WellCare of South Carolina Medicaid with Payer ID 14163. We are committed to improving the quality of life of our millions of members, who often include some of our nations most vulnerable populations. WellCare Medicare members are not affected by this change. UHC Community TFL - Timely filing Limit: 120 Days: Unitedhealthcare TFL - Timely filing Limit: Participating Providers: 90 days Non Participating Providers: 180 Days If its secondary payer: 90 days from date of Primary Explanation of Benefits Unitedhealthcare timely filing limit for appeals: 12 months from original claim determination The Medicare portion of the agreement will continue to function in its entirety as applicable. 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. As of April 1, 2021, WellCare will no longer be a separate plan option offered by South Carolina Healthy Connections Choices. 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. Providers can help facilitate timely claim payment by having an understanding of our processes and requirements. Obstetrician care provided by an out-of-network obstetrician will be covered for pregnant members inclusive of postpartum care. To do this: 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. You must ask within 30 calendar days of getting our decision. To do so by phone, call Member Services at 1-888-588-9842 (TTY1-877-247-6272). Coronavirus Disease 2019 (COVID-19) causes respiratory illness in people and can spread from person to person. Yes, Absolute Total Care and WellCare will continue to offer Medicare products under their current brands and product names, until further notice. You can also have a video visit with a doctor using your phone or computer. You, your friend, a relative, legal counsel or other spokesperson who has your written consent may ask for a State Fair Hearing. Download the free version of Adobe Reader. Awagandakami No, Absolute Total Care will continue to operate under the Absolute Total Care name.