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. Download the free version of Adobe Reader. If you wish to use a representative, then he or she must complete an Appointment of Representative (AOR) statement. Farmington, MO 63640-3821. DOS prior toApril 1, 2021: Processed by WellCare. 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 837P EDI transactions. BlueCross BlueShield of South Carolina Piedmont Service Center P.O. If Statement Range is April 2, 2021 through April 10, 2021, please send to Absolute Total Care. You can do this at any time during your appeal. 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. Pharmacy services prior to April 1, 2021 must be requested from WellCare of South Carolina. 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. WellCare Health Plans, Inc. (NYSE: WCG) is now offering a $120 credit per family, per year towards over-the-counter (OTC) items as part of its Medicaid program benefits in South Carolina. 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. Professional and Institutional Fee-For-Service EDI transactions should be submitted to WellCare of South Carolina Medicaid with Payer ID 14163. Wellcare uses cookies. P.O. We would like to help your billing department get your EDI (claims and real time) transactions processed as efficiently as possible. * Username. However, there will be no members accessing/assigned to the Medicaid portion of the agreement. The annual flu vaccine helps prevent the flu. Awagandakami L]4(f4/pn~YTZSp-5/O*F)e~p:a6o{x8r Professional and Institutional Encounter EDI transactions should be submitted to WellCare of South Carolina Medicaid with Payer ID 59354. Providers can help facilitate timely claim payment by having an understanding of our processes and requirements. Please use WellCare Payor ID 14163. South Carolina | Wellcare SOUTH CAROLINA Healthcare done well. 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 dates of service prior to April 1, 2021: All paper claim submissions can be mailed to: WellCare Health Plans You can file an appeal if you do not agree with our decision. You can ask for a State Fair Hearing after we make our appeal decision. 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. The current transaction means that WellCare of South Carolina Medicaid members are transitioning to Absolute Total Care and will become Absolute Total Care members, effective April 1, 2021. Living Well Quality of Care Medicaid Managed Care Medicaid and CHIP Quality Resource Library Improvement Initiatives Performance Measurement Releases & Announcements Enrollment Strategies Continuous Eligibility Express Lane Eligibility Lawfully Residing Immigrant Children & Pregnant Women Presumptive Eligibility Home & Community Based Services 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. Copyright 2023 Wellcare Health Plans, Inc. Wellcare Health Plans, Inc., complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Kasapulam ti tulong? Pharmacy services prior to 4/1/2021 must be requested from WellCare South Carolina. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. Contact Wellcare Prime Provider Service at 1-855-735-4398 if you have questions. We have licensed clinicians available to speak with you and to connect you to the support you need to feel better. Claims will be processed according to timely filing provisions in the providers WellCare Participating Provider Agreement. We will also send you a letter with our decision within 72 hours from receiving your appeal. 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. Explains rules and state, line of business and CMS-specific regulations regarding 837P EDI transactions. Earliest From Dates on or after April 1, 2021 should be filed to Absolute Total Care. Always verify timely filing requirements with the third party payor. Claims for services on or after April 1, 2021 should be filed to Absolute Total Care for processing. Wellcare uses cookies. z4M0(th`1Lf`M18c BIcJ[%4l JU2 _ s Overview & Resources WellCare of North Carolina partners with providers to develop and deliver high-quality, cost-effective health care solutions. Members can continue to receive services from their current WellCare provider as long as they remain covered under WellCare. Please use the From Date Institutional Statement Date. As of April 1, 2021, all WellCare of South Carolina Medicaid members will transfer to Absolute Total Care. Wellcare uses cookies. For general questions about claims submissions, call Provider Claims Services at 1-800-575-0418. We try to make filing claims with us as easy as possible. Select your topic and plan and click "Chat Now!" to chat with a live agent! Explains how to receive, load and send 834 EDI files for member information. Claims Submission, Correspondence and Contact Resources will stay the same for the Medicare line of business. For current information, visit the Absolute Total Care website. You can file the grievance yourself. Exceptions to the one-year time limit: a) Medicare Cost Sharing Claims . WellCare claims will be processed according to timely filing provisions in the providers WellCare Participating Provider Agreement. Absolute Total Care will honor those authorizations. Yes, Absolute Total Care and WellCare will continue to offer Medicare products under their current brands and product names, until further notice. (This includes your PCP or another provider.) To avoid rejections please split the services into two separate claim submissions. Attn: Grievance Department 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. Our fax number is 1-866-201-0657. It is 30 days to 1 year and more and depends on . It will let you know we received your appeal. It will tell you we received your grievance. This manual sets forth the policies and procedures that providers participating in the Wellcare Prime network are required tofollow. From Date Institutional Statement Dates on or after April 1, 2021 should be filed to Absolute Total Care. Copyright 2023 Wellcare Health Plans, Inc. 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 March 15, 2021. Box 31224 A. We must have your written permission before someone can file a grievance for you. You can ask in writing for a State Fair Hearing (hearing, for short). endstream endobj 1045 0 obj <>/Metadata 50 0 R/OpenAction 1046 0 R/Outlines 160 0 R/Pages 1042 0 R/StructTreeRoot 166 0 R/Type/Catalog/ViewerPreferences<>>> endobj 1046 0 obj <> endobj 1047 0 obj <>/Font<>/ProcSet[/PDF/Text/ImageC/ImageB/ImageI]/XObject<>>>/Rotate 0/StructParents 0/Tabs/S/TrimBox[0.0 0.0 612.0 792.0]/Type/Page>> endobj 1048 0 obj <>stream A. Symptoms are flu-like, including: Fever Coughing Box 100605 Columbia, SC 29260. You do not appeal within 10 calendar days from when the Plan mails an adverse Notice of Action, or you do not request a hearing within 10 calendar days from when the Plan mails an adverse Notice of Appeals Resolution whichever is later. 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. Absolute Total Care You must file your appeal within 60 calendar days from the date on the NABD. We will review it and send you a decision letter within 30 calendar days from receiving your appeal. The Medicare portion of the agreement will continue to function in its entirety as applicable. Go365 for Humana Healthy Horizons Members can register for the new Go365 for Humana Healthy Horizons wellness program and earn rewards for participating in healthy activities. An appeal is a request you can make when you do not agree with a decision we made about your care. Here are some guides we created to help you with claims filing. 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. WellCare and Absolute Total Care Medicare plans will continue to operate under current brands, product names and provider contracts, until further notice. You can get many of your Coronavirus-related questions answered here. 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. This includes providing assistance with accessing interpreter services and hearing impaired . P.O. Please use the From Date Institutional Statement Date. Here you will find the tools and resources you need to help manage your submission of claims and receipt of payments. Learn how you can help keep yourself and others healthy. Claims submission, correspondence, and contact resources will stay the same for the Medicare line of business. WellCare of South Carolina will be known as Absolute Total Care as of April 1, 2021. WellCare of South Carolinawants to ensure that claims are handled as efficiently as possible. They are called: State law allows you to make a grievance if you have any problems with us. 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. Payments mailed to providers are subject to USPS mailing timeframes. 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. R 1/70.3/Determining End Date of Timely Filing Period -- Receipt Date R 1/70.4/Determination of Untimely Filing and Resulting Actions R 1/70.5/Application to Special Claim Types R 1/70.6/Filing Claim Where General Time Limit Has Expired R 1/70.7/Exceptions Allowing Extension of Time Limit R 1/70.7.1/Administrative Error 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. Ancillary Claims Filing Reminders; ClaimsXten TM: Correct Coding Initiative Reference Guide; Inpatient Non-Reimbursable Charges/Unbundling Policy WellCare claims will be processed according to timely filing provisions in the providers WellCare Participating Provider Agreement. 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. 2023 Medicare and PDP Compare Plans and Enroll Now Notice of Non-Discrimination We comply with applicable Federal civil rights laws and do not discriminate on the basis of race, color, national origin, age, sex, or disability. 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 . B^E{h#XYQv;[ny3Hha1yx4v.sBy jWacQzyL.kHhwtQ~35!Rh#)p+sj31LcC)4*Z:IWIG@WTD- )n,! WellCare of South Carolina will be known as Absolute Total Care as of April 1, 2021. 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. Molina Healthcare of Michigan, 100 W. Big Beaver Road, Suite 600 Attn: Claims, Troy, MI 48084-5209 Or Fax to: (248) 925-1768. Register now. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. If you file a grievance or an appeal, we must be fair. 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. Learn more about how were supporting members and providers. To do this: Be sure to ask us to continue your benefits within the 10 calendar day time frame. Will Absolute Total Care change its name to WellCare? A. Earliest From Dates prior to April 1, 2021 should be filed to WellCare of South Carolina. For the latest COVID-19 news, visit the CDC. You will get a letter from us when any of these actions occur. Will my existing WellCare patients be assigned to my Absolute Total Care Panel? What will happen to unresolved claims prior to the membership transfer? 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. We expect this process to be seamless for our valued members and there will be no break in their coverage. WellCare of South Carolina will be known as Absolute Total Care as of April 1, 2021. You can also have a video visit with a doctor using your phone or computer. Section 1: General Information. If you need claim filing assistance, please contact your provider advocate. With the completion of this transaction, we have created a premier healthcare enterprise focused on government-sponsored healthcare programs. Search for primary care providers, hospitals, pharmacies, and more! Providers will continue to work directly with WellCare to address any claims for dates of service prior to the membership transfer of April 1, 2021. You and the person you choose to represent you must sign the AOR form. * Password. Incorrect forms will not be considered and may lead to further delays in processing prior authorization requests. Need an account? That's why we provide tools and resources to help.

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