We are simplifying Medicare so you can choose and use an affordable local plan that will help you achieve your best possible health. 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. Here you will find the tools and resources you need to help manage your submission of claims and receipt of payments. To do this: What is the Rx BIN and Group Number for WellCare members transitioning to Absolute Total Care on April 1, 2021? Download the free version of Adobe Reader. BlueCross BlueShield of South Carolina Piedmont Service Center P.O. 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. If an authorization is needed, you can log in to the Secure Provider Portal at absolutetotalcare.com to submit and confirm authorizations. Wellcare uses cookies. 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. Earliest From Dates prior to 4/1/2021 should be filed to WellCare of South Carolina. This manual sets forth the policies and procedures that providers participating in the Absolute Total Carenetwork are required tofollow. 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. Wellcare uses cookies. From Date Institutional Statement Dates on or after 4/1/2021 should be filed to Absolute Total Care. A. It was a smart move. Forgot Your Password? A. Member Sign-In. 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. We will notify you orally and in writing. Reimbursement Policies Providers are encouraged to sign up to receive EFT payments to avoid any payment delays. Symptoms are flu-like, including: Fever Coughing 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. WellCare claims will be processed according to timely filing provisions in the providers WellCare Participating Provider Agreement. Examples: If Statement Range is March 14, 2021 through April 3, 2021, please send to WellCare. Claims for services prior to April 1, 2021 should be filed to WellCare for processing. WellCare of South Carolina will be known as Absolute Total Care as of 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 We cannot disenroll you from our plan or treat you differently. Finding a doctor is quick and easy. Register now at https://www.payspanhealth.comor contact PaySpan at providersupport@payspanhealth.com, or 877-331-7154. Box 3050 If an authorization is needed, you can log in to the Secure Provider Portalto submit and confirm authorizations. 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. As of April 1, 2021 Absolute Total Care, a Centene company, is now the health plan for South Carolina Medicaid members. 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. Send your written appeal to: We must have your written consent before someone can file an appeal for you. They are called: State law allows you to make a grievance if you have any problems with us. Box 100605 Columbia, SC 29260. 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. Payments mailed to providers are subject to USPS mailing timeframes. 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. Q. 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. 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. 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. 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 claims will be processed according to timely filing provisions in the providers WellCare Participating Provider Agreement. The member will be encouraged to establish care with a new in network primary care provider/specialist prior to the end of the transition/continuity of care period to review present treatment plan and coordinate the member's medical care. It will let you know we received your appeal. 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. Do I need to do anything additional to provide services on or after 4/1/2021 if I am in network with both WellCare and 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. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. Additionally, WellCare will have a migration section on their provider page at publishing FAQs. Q. A. P.O. Claims for services prior to April 1, 2021 should be filed to WellCare for processing. 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. Tampa, FL 33631-3372. 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. WellCare is the health care plan that puts you in control. WellCare of South Carolinawants to ensure that claims are handled as efficiently as possible. 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 and the person you choose to represent you must sign the AOR statement. These SNP plans provide benefits beyond Original Medicare, and may include transportation to medical appointments and vision exams. DOS prior toApril 1, 2021: Processed by WellCare. If at any time you need help filing one, call us. Awagandakami Members will need to talk to their provider right away if they want to keep seeing him/her. 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 . A. P.O. March 14-March 31, 2021, please send to WellCare. Or it can be made if we take too long to make a care decision. A. They must inform their vendor of AmeriHealth Caritas . 2) Reconsideration or Claim disputes/Appeals. * Username. Please use the Earliest From Date. Members can continue to receive services from their current WellCare provider as long as they remain covered under WellCare. 1096 0 obj <>stream Instructions on how to submit a corrected or voided claim. We will call you with our decision if we decide you need a fast appeal. The participating provider agreement with WellCare will remain in-place after 4/1/2021. 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. Q. Wfu neebybfgnh bgWfulnybfgC South Carolina Medicaid Provider Resource Guide Thank you for being a star member of our provider team. A hearing officer from the State will decide if we made the right decision. You and the person you choose to represent you must sign the AOR form. Tampa, FL 33631-3384. 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. 1,flQ*!WLOmsmz\D;I5BI,yA#z!vYQi5'fedREF40 b666q1(UtUJJ.i` (T/@E Contact Absolute Total Care Provider Service at1-866-433-6041if youhave questions. Absolute Total Care will honor those authorizations. 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. We would like to help your billing department get your EDI (claims and real time) transactions processed as efficiently as possible. #~0 I 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. WellCare and Absolute Total Care Medicare plans will continue to operate under current brands, product names and provider contracts, until further notice. 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. Box 600601 Columbia, SC 29260. However, as of April 1, 2021, all WellCare of South Carolina Medicaid members will become Absolute Total Care members. We welcome Brokers who share our commitment to compliance and member satisfaction. North Carolina PHP Billing Guidance for Local W Code. The participating provider agreement with WellCare will remain in-place after 4/1/2021. 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. Box 8206 Q: What is Absolute Total Cares Transition/Continuity of Care Policy? We expect this process to be seamless for our valued members, and there will be no break in their coverage. 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. 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. To write us, send mail to: You can fax it too. 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. We try to make filing claims with us as easy as possible. We will give you information to help you get the most from your benefits and the services we provide. Will Absolute Total Care continue to offer Medicare and Marketplace products? Q. Division of Appeals and Hearings 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. Provider can't require members to appoint them as a condition of getting services. N .7$* P!70 *I;Rox3 ] LS~. You will get a letter from us when any of these actions occur. Claims for services on or after April 1, 2021 should be filed to Absolute Total Care for processing. Download the free version of Adobe Reader. For current information, visit the Absolute Total Care website. From Date Institutional Statement Dates prior to 4/1/2021 should be filed to WellCare of South Carolina. You can ask for a State Fair Hearing after we make our appeal decision. We must have your written permission before someone can file a grievance for you. A. Box 31224 Wellcare uses cookies.