pst/!+ Y^Ynwb7tw,eI^ April 1-April 3, 2021, please send to Absolute Total Care. A. Payments mailed to providers are subject to USPS mailing timeframes. We want you to let us know right away if you have any questions, grievances or problems with your covered services or the care you receive. Wellcare uses cookies. Claims Submission, Correspondence and Contact Resources will stay the same for the Medicare line of business. 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. Professional and Institutional Encounter EDI transactions should be submitted to WellCare of South Carolina Medicaid with Payer ID 59354. All billing requirements must be adher ed to by the provider in order to ensure timely processing of claims. The hearing officer will decide whether our decision was right or wrong. Explains rules and state, line of business and CMS-specific regulations regarding 837P EDI transactions. A. Transition/Continuity of Care is an extended period of time members are given when they join or transfer to another plan in order to receive services from out-of-network providers and/or pharmacies, until that specified period ends. From Date Institutional Statement Dates on or after 4/1/2021 should be filed to Absolute Total Care. Please contact our Provider Services Call Center at 1-888-898-7969. You now have access to a secure, quick way to electronically settle claims. To do so by phone, call Member Services at 1-888-588-9842 (TTY1-877-247-6272). Q. If an authorization is needed, you can log in to the Secure Provider Portal at absolutetotalcare.com to submit and confirm authorizations. We're here for you. South Carolina | Wellcare SOUTH CAROLINA Healthcare done well. We expect this process to be seamless for our valued members and there will be no break in their coverage. Providers interested in joining the Absolute Total Care Provider Network should submit a request to Network Development and Contracting via email at [email protected]. Q. If you think you might have been exposed, contact a doctor immediately. hYnH~}9'I`@>cLq,&DYH"W~&eJx'"luWU]JDBFRJ!*SN(s'6# ^*dg4$SB7K4z:r6')baka+Raf4J=)l, _/jaSpao69&&_Ln=?/{:,'z .1J0|~jv4[eUN{:-gl! K'&hng?y},&X/|OzcJ@0PhDiO})9RA9tG%=|rBhHBz7 2) Reconsideration or Claim disputes/Appeals. To do this: Be sure to ask us to continue your benefits within the 10 calendar day time frame. Box 100605 Columbia, SC 29260. Explains how to receive, load and send 834 EDI files for member information. A. Providers will continue to follow WellCares Medicaid policies and procedures for services provided to WellCare Medicaid members for dates of service prior to April 1, 2021. Our fax number is 1-866-201-0657. Division of Appeals and Hearings Obstetrician care provided by an out-of-network obstetrician will be covered for pregnant members inclusive of postpartum care. Register now at https://www.payspanhealth.com or contact PaySpan at [email protected], or 877-331-7154. Box 6000 Greenville, SC 29606. Q: What is Absolute Total Cares Transition/Continuity of Care Policy? 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. 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. 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. You or your authorized representative will tell the hearing officer why you think we made the wrong decision. WellCare and Absolute Total Care Medicare plans will continue to operate under current brands, product names and provider contracts, until further notice. Provider can't require members to appoint them as a condition of getting services. If your services are continued during an appeal or a hearing, you can keep getting them until: If the hearing is decided in your favor, well approve and pay for the care that is needed. It is 30 days to 1 year and more and depends on . Please Explore the Site and Get To Know Us. We are proud to announce that WellCare is now part of the Centene Family. Explains rules and state, line of business and CMS-specific regulations regarding 837I EDI transactions. Exceptions to the one-year time limit: a) Medicare Cost Sharing Claims . 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). We will give you information to help you get the most from your benefits and the services we provide. The provider needs to contact Absolute Total Care to arrange continuing care. Date of Occurrence/DOSprior toApril 1, 2021: Processed by WellCare. 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. 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. At WellCare, we value everything you do to deliver quality care to our members your patients and ensure they have a positive health care experience. PROVIDERS NOTE:Please send Corrected Claims as normal submissions via electronic or paper. As of April 1, 2021 Absolute Total Care, a Centene company, is now the health plan for South Carolina Medicaid members. Claims will be processed according to timely filing provisions in the providers WellCare Participating Provider Agreement. Tampa, FL 33631-3372. Refer to your particular provider type program chapter for clarification. Farmington, MO 63640-3821. Box 31384 Explains rules and state, line of business and CMS-specific regulations regarding 837I EDI transactions. We are committed to improving the quality of life of our millions of members, who often include some of our nations most vulnerable populations. We try to make filing claims with us as easy as possible. Providers can help facilitate timely claim payment by having an understanding of our processes and requirements. Shop or Enroll in a Plan Frequently Asked Questions Find a Doctor Download Digital ID Card Welcome Allwell Members! Utilize interactive health and wellness tools to help you manage conditions, improve your health and save money. and Human Services From Date Institutional Statement Dates on or after April 1, 2021 should be filed to Absolute Total Care. We process check runs daily, with the exception of Sundays, National Holidays, and the last day of the month. We are glad you joined our family! the timely filing limits due to the provider being unaware of a beneficiary's coverage. Get an annual flu shot today. We will review it and send you a decision letter within 30 calendar days from receiving your appeal. The onlineProvider Manual represents the most up-to-date information on Absolute Total Cares Medicaid Plan, programs, policies, and procedures. If Statement Range is April 2, 2021 through April 10, 2021, please send to Absolute Total Care. Coronavirus Disease 2019 (COVID-19) causes respiratory illness in people and can spread from person to person. Providers interested in joining the Absolute Total Care vision network for routine vision services can contact Envolve Vision at 1-800-531-2818. Q. As of April 1, 2021, WellCare will no longer be a separate plan option offered by South Carolina Healthy Connections Choices. WellCare Medicare members are not affected by this change. From Date Institutional Statement Dates prior to 4/1/2021 should be filed to WellCare of South Carolina. 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! A. 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. Copyright 2023 Wellcare Health Plans, Inc. Clinical Laboratory Improvement Amendments (CLIA). The participating provider agreement with WellCare will remain in-place after 4/1/2021. WellCare Medicare members are not affected by this change. L]4(f4/pn~YTZSp-5/O*F)e~p:a6o{x8r Please use WellCare Payor ID 14163. Wfu neebybfgnh bgWfulnybfgC South Carolina Medicaid Provider Resource Guide Thank you for being a star member of our provider team. March 14-March 31, 2021, please send to WellCare. WellCare claims will be processed according to timely filing provisions in the providers WellCare Participating Provider Agreement. Where should I submit claims for WellCare Medicaid members that transition to Absolute Total Care? Outpatient Prior Authorization Form (PDF) Inpatient Prior Authorization Form (PDF) (This includes your PCP or another provider.) From Date Institutional Statement Dates prior to April 1, 2021 should be filed to WellCare of South Carolina. Claims will be processed according to timely filing provisions in the providers Absolute Total Care Participating Provider Agreement. %PDF-1.6 % P.O. Copyright 2023 Wellcare Health Plans, Inc. Kasapulam ti tulong? Farmington, MO 63640-3821. Contact Us Y0020_WCM_100876E Last Updated On: 10/1/2022 A. Professional and Institutional Encounter EDI transactions should be submitted to WellCare of South Carolina Medicaid with Payer ID 59354. You and the person you choose to represent you must sign the AOR form. Here you will find the tools and resources you need to help manage your submission of claims and receipt of payments.