Pharmacy services prior to 4/1/2021 must be requested from WellCare South Carolina. Please use WellCare Payor ID 14163. 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. We are proud to announce that WellCare is now part of the Centene Family. We cannot disenroll you from our plan or treat you differently. Reimbursement Policies Professional and Institutional Fee-For-Service EDI transactions should be submitted to WellCare of South Carolina Medicaid with Payer ID 14163. Please use the From Date Institutional Statement Date. 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. The hearing officer does not decide in your favor. WellCare and Absolute Total Care Medicare plans will continue to operate under current brands, product names and provider contracts, until further notice. 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). Absolute Total Care will honor all existing WellCare authorization approvals that include dates of service beyond March 31, 2021. 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. 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. For additional information, questions or concerns, please contact your local Provider Network Management Representative. Explains rules and state, line of business and CMS-specific regulations regarding 837I EDI transactions. We want to ensure that claims are handled as efficiently as possible. WellCare is the health care plan that puts you in control. 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. Providers interested in joining the Absolute Total Care provider network should submit a request to the Network Development and Contracting Department via email at atc_contracting@centene.com. If you need claim filing assistance, please contact your provider advocate. Learn how you can help keep yourself and others healthy. WellCare of South Carolina will be known as Absolute Total Care as of April 1, 2021. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. We expect this process to be seamless for our valued members and there will be no break in their coverage. The onlineProvider Manual represents the most up-to-date information on Absolute Total Cares Medicaid Plan, programs, policies, and procedures. You may do this in writing or in person. These grievances may be about: The state of South Carolina allows members to file a grievance at anytime from the event that caused the dissatisfaction. If you wish to use a representative, then he or she must complete an Appointment of Representative (AOR) statement. An appeal is a request you can make when you do not agree with a decision we made about your care. Your second-level review will be performed by person(s) not involved in the first review. Contact Wellcare Prime Provider Service at 1-855-735-4398 if you have questions. How do I join Absolute Total Cares provider network? Claims for services on or after April 1, 2021 should be filed to Absolute Total Care for processing. Box 8206 Box 8206 Columbia, SC 29202-8206 Or call 1-800-763-9087. 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. Wellcare uses cookies. Or you can have someone file it for you. To do so by phone, call Member Services at 1-888-588-9842 (TTY1-877-247-6272). 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 %%EOF We expect this process to be seamless for our valued members and there will be no break in their coverage. Please contact our Provider Services Call Center at 1-888-898-7969. Our call centers, including the nurse advice line, are currently experiencing high volume. An authorized representative is someone you select to act on the behalf of a member to assist them through the appeals process. To have someone represent you, you must complete an Appointment of Representative (AOR) form. The benefit can be used to get more than 150 items - including vitamins, pain relievers, cold and allergy medicines, baby wipes, and diapers - at no cost . Q. Here are some guides we created to help you with claims filing. For the latest COVID-19 news, visit the CDC. 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 You must file your appeal within 60 calendar days from the date on the NABD. 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. 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. 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. P.O. Keep yourself informed about Coronavirus (COVID-19.) P.O. There is a lot of insurance that follows different time frames for claim submission. A. Members can continue to receive services from their current WellCare provider as long as they remain covered under WellCare. Earliest From Dates prior to 4/1/2021 should be filed to WellCare of South Carolina. endstream endobj startxref 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. You can do this at any time during your appeal. Always verify timely filing requirements with the third party payor. 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. As of April 1, 2021, all WellCare of South Carolina Medicaid members will transfer to Absolute Total Care. What will happen to my Participating Provider Agreement with WellCare after 4/1/2021? Thanka kaa yoa Tufrbeau ingsnh ngetfu South Caralaita nouMa mpvd. It was a smart move. z4M0(th`1Lf`M18c BIcJ[%4l JU2 _ s This manual sets forth the policies and procedures that providers participating in the Wellcare Prime network are required to follow. Can I continue to see my current WellCare members? 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. As of April 1, 2021, all WellCare of South Carolina Medicaid members will become Absolute Total Care members. 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. More Information Need help? It can also be about a provider and/or a service. 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. Q. Reconsideration or Claim Disputes/Appeals: 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. DOS prior toApril 1, 2021: Processed by WellCare. Written notice is not needed if your expedited appeal request is filed verbally. All dates of service prior to 4/1/2021 should be filed to WellCare of South Carolina. Providers interested in joining the Absolute Total Care vision network for routine vision services can contact Envolve Vision at 1-800-531-2818. We will give you information to help you get the most from your benefits and the services we provide. Those who attend the hearing include: You can also request to have your hearing over the phone. 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. Q. To earn rewards, members must: Download the Go365 for Humana Healthy Horizons app onto a mobile device from the Apple App Store or Google Play. Utilize interactive health and wellness tools to help you manage conditions, improve your health and save money. Absolute Total Care Providers are encouraged to visit the Provider Resources webpageformanuals, forms, clinical policies, payment policies, provider news and resources related to claims submission, eligibility, prior authorization and more. ?-}++lz;.0U(_I]:3O'~3-~%-JM 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. You will need Adobe Reader to open PDFs on this site. WellCare of South Carolina will be known as Absolute Total Care as of April 1, 2021. Here you will find the tools and resources you need to help manage your submission of claims and receipt of payments. However, there will be no members accessing/assigned to the Medicaid portion of the agreement. We expect this process to be seamless for our valued members, and there will be no break in their coverage. Examples: If Statement Range is March 14, 2021 through April 3, 2021, please send to WellCare. Our toll-free fax number is 1-877-297-3112. For example, if a payer has a 90-day timely filing requirement, that means you need to submit the claim within 90 days of the date of service. Instructions on how to submit a corrected or voided claim. Please use the From Date Institutional Statement Date. Prior authorizations issued by WellCare for dates of service on or after April 1, 2021 will transfer with the members eligibility to Absolute Total Care.
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