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. Q. WellCare of South Carolina will be known as Absolute Total Care as of April 1, 2021. All dates of service prior to April 1, 2021 should be filed to WellCare of South Carolina. More Information Coronavirus (COVID-19) 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. ?-}++lz;.0U(_I]:3O'~3-~%-JM 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. With the completion of this transaction, we have created a premier healthcare enterprise focused on government-sponsored healthcare programs. Absolute Total Care will honor those authorizations. Please be sure to use the correct line of business prior authorization form for prior authorization requests. Those who attend the hearing include: You can also request to have your hearing over the phone. We expect this process to be seamless for our valued members and there will be no break in their coverage. Download the free version of Adobe Reader. 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. Please use the earliest From Date. You and the person you choose to represent you must sign the AOR form. WellCare claims will be processed according to timely filing provisions in the providers WellCare Participating Provider Agreement. WellCare offers participating providers EFT and ERA services at no charge through PaySpan Health. With the completion of this transaction, we have created a premier healthcare enterprise focused on government-sponsored healthcare programs. You will get a letter from us when any of these actions occur. You can file your appeal by calling or writing to us. We will also send you a letter with our decision within 72 hours from receiving your appeal. If an authorization is needed, you can log in to the Secure Provider Portalto submit and confirm authorizations. Providers interested in joining the Absolute Total Care vision network for routine vision services can contact Envolve Vision at 1-800-531-2818. You may do this in writing or in person. We will review it and send you a decision letter within 30 calendar days from receiving your appeal. However, as of April 1, 2021, all WellCare of South Carolina Medicaid members will become Absolute Total Care members. For the latest COVID-19 news, visit the CDC. A. 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. Box 3050 Here you will find the tools and resources you need to help manage your submission of claims and receipt of payments. 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. Wellcare uses cookies. Contact Absolute Total Care Provider Service at1-866-433-6041if youhave questions. A. Claims for services on or after April 1, 2021 should be filed to Absolute Total Care for processing. Authorizations already processed by WellCare for any services on or after April 1, 2021, will be moved to Absolute Total Care and there is no need for the provider or member to request these services again. The Medicare portion of the agreement will continue to function in its entirety as applicable. Yes, Absolute Total Care and WellCare will continue to offer Medicare products under their current brands and product names, until further notice. Timely Filing Limits for all Insurances updated (2023) We try to make filing claims with us as easy as possible. South Carolina Medicaid & Health Insurance | Absolute Total Care What will happen to unresolved claims prior to the membership transfer? South Carolina : Login 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. WellCare claims will be processed according to timely filing provisions in the providers WellCare Participating Provider Agreement. Copyright 2023 Wellcare Health Plans, Inc. Refer to your particular provider type program chapter for clarification. An appeal may be filed within 60 calendar days from the date on the Adverse Benefit Determination Notice. 1096 0 obj
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We are glad you joined our family! Q. How do I join Absolute Total Cares provider network? We comply with applicable Federal civil rights laws and do not discriminate on the basis of race, color, national origin, age, sex, or disability. Members will need to talk to their provider right away if they want to keep seeing him/her. Paper Claim Submission Submit paper claims to: WellCare Health Plans Electronic Claim Submission To initiate electronic claims, both in-network and out-of-network providers should contact their practice management software vendor or EDI software vendor. Visit https://msp.scdhhs.gov/appeals/ to: Copyright 2023 Wellcare Health Plans, Inc. https://msp.scdhhs.gov/appeals/site-page/file-appeal, If we deny or limit a service you or your doctor asks us to approve, If we reduce, suspend or stop services youve been getting that we already approved, If we do not pay for the health care services you get, If we fail to give services in the required timeframe, If we fail to give you a decision in the required timeframe on an appeal you already filed, If we dont agree to let you see a doctor who is not in our network and you live in a rural area or in an area with limited doctors, If you dont agree with a decision we made regarding your medicine, We denied your request to dispute a financial liability, The member did not personally receive the notice of action or received the notice late, The member was seriously ill, which prevented a timely appeal, There was a death or serious illness in the members immediate family, An accident caused important records to be destroyed, Documentation was difficult to locate within the time limits; and/or the member had incorrect or incomplete information concerning the appeals process, Change the appeal to the timeframe for a standard decision (30 calendar days), Follow up with a written letter within 2 calendar days, Tell you over the phone and in writing that you may file a grievance about the denial of the fast appeal request, Be in writing and specify the reason for the request, Include your name, address and phone number, Indicate the date of service or the type of service denied, Your authorized representative (if youve chosen one), A hearing officer from Medicaid and Long-Term Care (MLTC), You or your authorized representative with your written consent must file your appeal with us and ask to continue your benefits within 10 calendar days after we mail the Notice of Adverse benefit determination; or, Within 10 calendar days of the intended effective date of the plans proposed action, whichever is later, The appeal or hearing must address the reduction, suspension or stopping of a previously authorized service, The services were ordered by an authorized provider, The period covered by the original authorization cannot have ended. 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. DOS prior to April 1, 2021: Processed by WellCare. 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. Send your written appeal to: We must have your written consent before someone can file an appeal for you. Login - WellCare Addakam ditoy para kenka. You can get many of your Coronavirus-related questions answered here. Q. 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. Payments mailed to providers are subject to USPS mailing timeframes. %PDF-1.6
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If Medicare is the primary payer, timely filing is determined from the processing date indicated on the primary carrier's explanation of benefit (EOB) If Medicare is the Secondary Payer (MSP), the initial claim must be submitted to the primary payer within Cigna's timely filing period. Provider can't require members to appoint them as a condition of getting services. You or your authorized representative will tell the hearing officer why you think we made the wrong decision. 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. Farmington, MO 63640-3821. Providers can help facilitate timely claim payment by having an understanding of our processes and requirements. Forgot Your Password? WellCare Medicare members are not affected by this change. WellCare understands that having access to the right tools can help you and your staff streamline day-to-day administrative tasks. Providers are encouraged to sign up to receive EFT payments to avoid any payment delays. Timely filing is when you file a claim within a payer-determined time limit. If you wish to use a representative, then he or she must complete an Appointment of Representative (AOR) statement. 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. Symptoms are flu-like, including: Fever Coughing Integration FAQs | Absolute Total Care We are simplifying Medicare so you can choose and use an affordable local plan that will help you achieve your best possible health. Members will receive a 90-day transition of care period if the member is receiving ongoing care and treatment. We are proud to announce that WellCare is now part of the Centene Family. They are called: State law allows you to make a grievance if you have any problems with us. From Date Institutional Statement Dates on or after 4/1/2021 should be filed to Absolute Total Care. 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. Member Sign-In. All dates of service on or after 4/1/2021 should be filed to Absolute Total Care. B^E{h#XYQv;[ny3Hha1yx4v.sBy jWacQzyL.kHhwtQ~35!Rh#)p+sj31LcC)4*Z:IWIG@WTD- )n,! Q. Initial Claims: 120 Days from the Date of Service. PDF All Medicaid Bulletin - Sc Dhhs Timely Filing Limit: Timely Filing Limit is the time frame set by insurance companies and provider has to submit health care claims to respective insurance company within the set time frame for reimbursement of the claims. A. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. Claims Submission, Correspondence and Contact Resources will stay the same for the Medicare line of business. Additionally, WellCare will have a migration section on their provider page at
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