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. S< 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. Claims will be processed according to timely filing provisions in the providers Absolute Total Care Participating Provider Agreement. Please use the From Date Institutional Statement Date. Contact Wellcare Prime Provider Service at1-855-735-4398if youhave questions. 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. 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. (This includes your PCP or another provider.) Utilize interactive health and wellness tools to help you manage conditions, improve your health and save money. A. 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. Additionally, WellCare will have a migration section on their provider page at publishing FAQs. We are simplifying Medicare so you can choose and use an affordable local plan that will help you achieve your best possible health. You can file a grievance by calling or writing to us. If at any time you need help filing one, call us. A. You will receive an acknowledgement letter within 5 business days, and we will send you a resolution within 90 calendar days. Date of Occurrence/DOSApril 1, 2021 and after: Processed by Absolute Total Care. $8v + Yu @bAD`K@8m.`:DPeV @l 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. Search for primary care providers, hospitals, pharmacies, and more! The rules include what we must do when we get a grievance. Payments mailed to providers are subject to USPS mailing timeframes. Will Absolute Total Care change its name to WellCare? You or your authorized representative can review the information we used to make our decision. All dates of service on or after April 1, 2021 should be filed to Absolute Total Care. At the hearing, well explain why we made our decision. Division of Appeals and Hearings endstream endobj startxref Shop or Enroll in a Plan Frequently Asked Questions Find a Doctor Download Digital ID Card Welcome Allwell Members! Q. Claims will be processed according to timely filing provisions in the providers Absolute Total Care Participating Provider Agreement. From Date Institutional Statement Dates prior to April 1, 2021 should be filed to WellCare of South Carolina. If you think you might have been exposed, contact a doctor immediately. The provider needs to contact Absolute Total Care to arrange continuing care. The onlineProvider Manual represents the most up-to-date information on Absolute Total Cares Medicaid Plan, programs, policies, and procedures. When can providers begin requesting prior authorization from Absolute Total Care for WellCare Medicaid members for dates of service on or after April 1, 2021? 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. How do I determine if an institutional inpatient bill type submission overlapping 4/1/2021 should be filed to WellCare or Absolute Total Care? A. These materials are for informational purposes only. Q. We will give you information to help you get the most from your benefits and the services we provide. WellCare of South Carolina will be known as Absolute Total Care as of April 1, 2021. You will get a letter from us when any of these actions occur. WellCare has partnered with Change Healthcare as our preferred EDI Clearinghouse. The provider needs to contact Absolute Total Care to arrange continuing care. A. 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. An appeal may be filed within 60 calendar days from the date on the Adverse Benefit Determination Notice. You and the person you choose to represent you must sign the AOR statement. 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. It is called a "Notice of Adverse Benefit Determination" or "NABD." #~0 I 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. We expect this process to be seamless for our valued members, and there will be no break in their coverage. 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. Box 31384 In South Carolina, WellCare and Absolute Total Care are joining to better serve you. Box 8206 Columbia, SC 29202-8206 Or call 1-800-763-9087. 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. If you ask for a fast appeal and we decide that one is not needed, we will: You or your authorized representative can give us more information if you think itll help your appeal (regular or fast). April 1-April 3, 2021, please send to Absolute Total Care. Earliest From Dates on or after 4/1/2021 should be filed to Absolute Total Care. No, Absolute Total Care will continue to operate under the Absolute Total Care name. 1,flQ*!WLOmsmz\D;I5BI,yA#z!vYQi5'fedREF40 b666q1(UtUJJ.i` (T/@E It can also be about a provider and/or a service. Download the free version of Adobe Reader. Guides Filing Claims with WellCare. Providers interested in joining the Absolute Total Care vision network for routine vision services can contact Envolve Vision at 1-800-531-2818. For current information, visit the Absolute Total Care website. We expect this process to be seamless for our valued members, and there will be no break in their coverage. Register now at https://www.payspanhealth.com or contact PaySpan at providersupport@payspanhealth.com, or 877-331-7154. Reconsideration or Claim Disputes/Appeals: The Medicare portion of the agreement will continue to function in its entirety as applicable. Tampa, FL 33631-3372. Box 100605 Columbia, SC 29260. Download the free version of Adobe Reader. South Carolina | Wellcare SOUTH CAROLINA Healthcare done well. 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! Members can continue to receive services from their current WellCare provider as long as they remain covered under WellCare. Ambetter Timely Filing Limit of : 1) Initial Claims. Q. Select Health Claims must be filed within 12 months from the date of service. We welcome Brokers who share our commitment to compliance and member satisfaction. Absolute Total Care will honor those authorizations. 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. You can get many of your Coronavirus-related questions answered here. Absolute Total Care will continue to offer Marketplace products under the Ambetter brand. PROVIDERS NOTE:Please send Corrected Claims as normal submissions via electronic or paper. z4M0(th`1Lf`M18c BIcJ[%4l JU2 _ s 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. You can get many of your Coronavirus-related questions answered here. Explains rules and state, line of business and CMS-specific regulations regarding 837I EDI transactions. 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. Professional and Institutional Encounter EDI transactions should be submitted to WellCare of South Carolina Medicaid with Payer ID 59354. %%EOF Prior authorizations issued by WellCare for dates of service on or after 4/1/2021 will transfer with the members eligibility to 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. Q: What is Absolute Total Cares Transition/Continuity of Care Policy? WellCare Medicare members are not affected by this change. Learn more about how were supporting members and providers. 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. Timely Filing Limits for all Insurances updated (2023) - Bcbsproviderphonenumber Timely Filing Limits for all Insurances updated (2023) One of the common and popular denials is passed the timely filing limit. Payments mailed to providers are subject to USPS mailing timeframes. For the latest COVID-19 news, visit the CDC. 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. If an authorization is needed, you can log in to the Secure Provider Portal at absolutetotalcare.com to submit and confirm authorizations. Wfu neebybfgnh bgWfulnybfgC South Carolina Medicaid Provider Resource Guide Thank you for being a star member of our provider team. Instructions on how to submit a corrected or voided claim. Explains rules and state, line of business and CMS-specific regulations regarding 837P EDI transactions.

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