The Medicare portion of the agreement will continue to function in its entirety as applicable. Explains how to receive, load and send 834 EDI files for member information. Q. 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. We try to make filing claims with us as easy as possible. The participating provider agreement with WellCare will remain in-place after April 1, 2021. Exceptions to the one-year time limit: a) Medicare Cost Sharing Claims . The hearing officer does not decide in your favor. A. Tampa, FL 33631-3384. ?-}++lz;.0U(_I]:3O'~3-~%-JM All dates of service on or after April 1, 2021 should be filed to Absolute Total Care. A. As of April 1, 2021, all WellCare of South Carolina Medicaid members will become Absolute Total Care members. 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. We want to ensure that claims are handled as efficiently as possible. We welcome Brokers who share our commitment to compliance and member satisfaction. Select Health Claims must be filed within 12 months from the date of service. You must file your appeal within 60 calendar days from the date on the NABD. Please use the From Date Institutional Statement Date. endstream
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A. Absolute Total Care will honor all existing WellCare authorization approvals that include dates of service beyond March 31, 2021. Additionally, WellCare will have a migration section on their provider page at publishing FAQs. A grievance is when you tell us about a concern you have with our plan. 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. For example, if any patient gets services on the 1st of any month then there is a time limit to submit his/her claim to the insurance company for reimbursement. We process check runs daily, with the exception of Sundays, National Holidays, and the last day of the month. #~0 I
2) Reconsideration or Claim disputes/Appeals. Molina Healthcare of Michigan, 100 W. Big Beaver Road, Suite 600 Attn: Claims, Troy, MI 48084-5209 Or Fax to: (248) 925-1768. A. We are simplifying Medicare so you can choose and use an affordable local plan that will help you achieve your best possible health. State Health Plan State Claims P.O. However, as of April 1, 2021, all WellCare of South Carolina Medicaid members will become Absolute Total Care members. The Medicare portion of the agreement will continue to function in its entirety as applicable. You will need Adobe Reader to open PDFs on this site. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. We comply with applicable Federal civil rights laws and do not discriminate on the basis of race, color, national origin, age, sex, or disability. To do this: \{-w{,xI202100$0*bZf ,X AayhP3pYla" e 3G& `eoT#@ *;d
A hearing officer from the State will decide if we made the right decision. z4M0(th`1Lf`M18c BIcJ[%4l JU2 _
s We cannot disenroll you from our plan or treat you differently. Wellcare uses cookies. What will happen to unresolved claims prior to the membership transfer? 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. UHC Community TFL - Timely filing Limit: 120 Days: Unitedhealthcare TFL - Timely filing Limit: Participating Providers: 90 days Non Participating Providers: 180 Days If its secondary payer: 90 days from date of Primary Explanation of Benefits Unitedhealthcare timely filing limit for appeals: 12 months from original claim determination Your second-level review will be performed by person(s) not involved in the first review. Ancillary Claims Filing Reminders; ClaimsXten TM: Correct Coding Initiative Reference Guide; Inpatient Non-Reimbursable Charges/Unbundling Policy You or your provider must call or fax us to ask for a fast appeal. As of April 1, 2021, all WellCare of South Carolina Medicaid members will transfer to Absolute Total Care. 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. Symptoms are flu-like, including: Fever Coughing If you file a grievance or an appeal, we must be fair. 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 also send you a letter with our decision within 72 hours from receiving your appeal. 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. Ambetter from Absolute Total Care - South Carolina. A. Hearings are used when you were denied a service or only part of the service was approved. It was a smart move. We are proud to announce that WellCare is now part of the Centene Family. All dates of service prior to April 1, 2021 should be filed to WellCare of South Carolina. We will call you with our decision if we decide you need a fast appeal. 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. Know the facts about Coronavirus (COVID-19) Our call centers, including the nurse advice line, are currently experiencing high volume. Providers are encouraged to visit the Provider Resources webpagefor manuals, forms, and resources related to claims submission, eligibility, prior authorization, and more. PROVIDER REMINDER: It is important that providers check eligibility prior to providing services as members can potentially change plans prior to 4/1/2021 if they are in the annual choice period. How do I bill a professional submission with services spanning before and after 04/01/2021? If you dont, we will have to deny your request. If an authorization is needed, you can log in to the Secure Provider Portalto submit and confirm authorizations. You can do this at any time during your appeal. This gives members time to establish with a new provider in the network and ensure that they have continuity of care. A. 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. You can get many of your Coronavirus-related questions answered here. 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. Claims Submission, Correspondence and Contact Resources will stay the same for the Medicare line of business. You will have a limited time to submit additional information for a fast appeal. P.O. 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. Q. We will send you another letter with our decision within 90 days or sooner. Member Sign-In. A. 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. You can file an appeal if you do not agree with our decision. These SNP plans provide benefits beyond Original Medicare, and may include transportation to medical appointments and vision exams. Q. How do I determine if a professional or an outpatient bill type institutional submission should be filed to WellCare or Absolute Total Care? The provider needs to contact Absolute Total Care to arrange continuing 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. WellCare claims will be processed according to timely filing provisions in the providers WellCare Participating Provider Agreement. Pharmacy services prior to 4/1/2021 must be requested from WellCare South Carolina. We may apply a 14 day extension to your grievance resolution. You, your friend, a relative, legal counsel or other spokesperson who has your written consent may ask for a State Fair Hearing. We encourage you to check the Medicaid Pre-Auth Check Toolto ensure that you are accessing the most current Absolute Total Care authorization requirements for dates of service on or after April 1, 2021. Providers are encouraged to sign up to receive EFT payments to avoid any payment delays. 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. A. Box 31224 We will review it and send you a decision letter within 30 calendar days from receiving your appeal. In this section, we will explain how you can tell us about these concerns/grievances. Register now at https://www.payspanhealth.comor contact PaySpan at providersupport@payspanhealth.com, or 877-331-7154. Absolute Total Care will honor those authorizations. P.O. Where should I submit claims for WellCare Medicaid members? Professional and Institutional Fee-For-Service EDI transactions should be submitted to WellCare of South Carolina Medicaid with Payer ID 14163. All dates of service on or after 4/1/2021 should be filed to Absolute Total Care. For the latest COVID-19 news, visit the CDC. 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. WellCare and Absolute Total Care Medicare plans will continue to operate under current brands, product names and provider contracts, until further notice. The Claim Reconsideration process is an informal claim review, and is not a substitute for an appeal of a final agency decision. WellCare of South Carolinawants to ensure that claims are handled as efficiently as possible. 8h} \x p`03
1z`@+`~70 G ~Ws5Puick79,4 ,O5@?O-Gr'|5Oj:v6/` Q. 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. Providers interested in joining the Absolute Total Care Provider Network should submit a request to Network Development and Contracting via email at. You can ask for a State Fair Hearing after we make our appeal decision. If Statement Range is April 2, 2021 through April 10, 2021, please send to Absolute Total Care. 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 may request a State Fair Hearing at this address: South Carolina Department of Health WellCare Medicare members are not affected by this change. For general questions about claims submissions, call Provider Claims Services at 1-800-575-0418. By continuing to use our site, you agree to our Privacy Policy and Terms of Use.