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. Q. Our toll-free fax number is 1-877-297-3112. For additional information, questions or concerns, please contact your local Provider Network Management Representative. Wellcare uses cookies. Provider can't require members to appoint them as a condition of getting services. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. You can file the grievance yourself. 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. For dates of service on or after April 1, 2021: Absolute Total Care As of April 1, 2021, all WellCare of South Carolina Medicaid members will transfer to Absolute Total Care. With the completion of this transaction, we have created a premier healthcare enterprise focused on government-sponsored healthcare programs. Additionally, WellCare will have a migration section on their provider page at publishing FAQs. Section 1: General Information. A grievance is when you tell us about a concern you have with our plan. Your second-level review will be performed by person(s) not involved in the first review. Q. Reimbursement Policies At the hearing, well explain why we made our decision. Q. WellCare and Absolute Total Care Medicare plans will continue to operate under current brands, product names and provider contracts, until further notice. PROVIDER REMINDER: It is important that providers check eligibility prior to providing services as members can potentially change plans prior to 4/1/2021 if they are in the annual choice period. 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. endstream
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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. 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. 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. WellCare of South Carolina will be known as Absolute Total Care as of April 1, 2021. Check out the Interoperability Page to learn more. People of all ages can be infected. Copyright 2023 Wellcare Health Plans, Inc. 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. We will give you information to help you get the most from your benefits and the services we provide. We must have your written permission before someone can file a grievance for you. Within five business days of getting your grievance, we will mail you a letter. As a member you may request a 14 day extension of your grievance, you may do so by calling Member Services at 1-888-588-9842 (TTY 1-877-247-6272) or You may send your request for extension in writing to: WellCare Health Plans 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. Explains how to receive, load and send 834 EDI files for member information. For example, if any patient gets services on the 1st of any month then there is a time limit to submit his/her claim to the insurance company for reimbursement. To continue care with their current provider after the 90-day Transition of Care, the provider must agree to work with Absolute Total Care on the member's care and accept Absolute Total Care's payment rates. 2023 Medicare and PDP Compare Plans and Enroll Now. Tampa, FL 33631-3372. 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. Date of Occurrence/DOSApril 1, 2021 and after: Processed by Absolute Total Care. Attn: Grievance Department Will WellCare continue to offer current products or Medicare only? 8h} \x p`03
1z`@+`~70 G ~Ws5Puick79,4 ,O5@?O-Gr'|5Oj:v6/` 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. We try to make filing claims with us as easy as possible. If Statement Range is March 14, 2021 through April 3, 2021, please send to WellCare. The participating provider agreement with WellCare will remain in-place after April 1, 2021. No, Absolute Total Care will continue to operate under the Absolute Total Care name. * Username. 1044 0 obj
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The Claim Reconsideration process is an informal claim review, and is not a substitute for an appeal of a final agency decision. 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 . Wellcare uses cookies. 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. All transitioning Medicaid members will receive a welcome packet and new member ID card from Absolute Total Care in March 2021 and will use the Absolute Total Care ID card to get prescriptions and access healthcare services starting April 1, 2021. We comply with applicable Federal civil rights laws and do not discriminate on the basis of race, color, national origin, age, sex, or disability. As of April 1, 2021, all WellCare of South Carolina Medicaid members will become Absolute Total Care members. First Choice can accept claim submissions via paper or electronically (EDI). For the death or injury of a member of the South Carolina National Guard, as provided for in Section 42-7-67, the time for filing a claim is two years after the accident or one year after the federal claim is finalized, whichever is later. 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. Explains how to receive, load and send 834 EDI files for member information. 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. Absolute Total Care will honor all existing WellCare authorization approvals that include dates of service beyond March 31, 2021. Members will need to talk to their provider right away if they want to keep seeing him/her. 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. A. As of April 1, 2021, WellCare will no longer be a separate plan option offered by South Carolina Healthy Connections Choices. Columbia, SC 29202-8206. Contact Us Y0020_WCM_100876E Last Updated On: 10/1/2022 hb```b``6``e`~ "@1V
NB, This gives members time to establish with a new provider in the network and ensure that they have continuity of care. Or it can be made if we take too long to make a care decision. We will continue covering your medical services during your appeal request and State Fair Hearing if all of the following are meet. Wfu neebybfgnh bgWfulnybfgC South Carolina Medicaid Provider Resource Guide Thank you for being a star member of our provider team. With the completion of this transaction, we have created a premier healthcare enterprise focused on government-sponsored healthcare programs. 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. Incorrect forms will not be considered and may lead to further delays in processing prior authorization requests. the timely filing limits due to the provider being unaware of a beneficiary's coverage. WellCare claims will be processed according to timely filing provisions in the providers WellCare Participating Provider Agreement. All billing requirements must be adher ed to by the provider in order to ensure timely processing of claims. Thanka kaa yoa Tufrbeau ingsnh ngetfu South Caralaita nouMa mpvd. P.O. Payments mailed to providers are subject to USPS mailing timeframes. The materials located on our website are for dates of service prior to April 1, 2021. The onlineProvider Manual represents the most up-to-date information on Absolute Total Cares Medicaid Plan, programs, policies, and procedures. WellCare of North Carolina partners with providers to develop and deliver high-quality, cost-effective health care solutions. Copyright 2023 Wellcare Health Plans, Inc. The rules include what we must do when we get a grievance. Tampa, FL 33631-3372. 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). 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. Q. The timely filing limit is the time duration from service rendered to patients and submitting claims to the insurance companies. If Statement Range is April 2, 2021 through April 10, 2021, please send to Absolute Total Care. WellCare credentialing cycles will be shared with Absolute Total Care in order to reduce duplicative credentialing in the future. Providers interested in joining the Absolute Total Care vision network for routine vision services can contact Envolve Vision at 1-800-531-2818.
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