You can also have a video visit with a doctor using your phone or computer. Members will receive a 90-day transition of care period if the member is receiving ongoing care and treatment. You will have a limited time to submit additional information for a fast appeal. A. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. Members will need to talk to their provider right away if they want to keep seeing him/her. 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 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. Only you or your authorizedrepresentative can ask for a State Fair Hearing. We must have your written permission before someone can file a grievance for you. As of April 1, 2021, all WellCare of South Carolina Medicaid members will transfer to Absolute Total Care. \{-w{,xI202100$0*bZf ,X AayhP3pYla" e 3G& `eoT#@ *;d Absolute Total Care will honor those authorizations. Obstetrician care provided by an out-of-network obstetrician will be covered for pregnant members inclusive of postpartum care. An authorized representative is someone you select to act on the behalf of a member to assist them through the appeals process. You can file a grievance by calling or writing to us. hb```b``6``e`~ "@1V NB, However, there will be no members accessing/assigned to the Medicaid portion of the agreement. The Medicare portion of the agreement will continue to function in its entirety as applicable. Farmington, MO 63640-3821. Download the free version of Adobe Reader. All Paper Claim Submissions can be mailed to: WellCare Health Plans and Human Services With the completion of this transaction, we have created a premier healthcare enterprise focused on government-sponsored healthcare programs. Additionally, WellCare will have a migration section on their provider page at publishing FAQs. A. To have someone represent you, you must complete an Appointment of Representative (AOR) form. We would like to help your billing department get your EDI (claims and real time) transactions processed as efficiently as possible. If Statement Range is April 2, 2021 through April 10, 2021, please send to Absolute Total Care. Absolute Total Care You may request a State Fair Hearing at this address: South Carolina Department of Health We welcome Brokers who share our commitment to compliance and member satisfaction. 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. No, Absolute Total Care will continue to operate under the Absolute Total Care name. Authorizations already processed by WellCare for any services on or after April 1, 2021, will be moved to Absolute Total Care and there is no need for the provider or member to request these services again. Or it can be made if we take too long to make a care decision. Tampa, FL 33631-3372. Kasapulam ti tulong? In this section, we will explain how you can tell us about these concerns/grievances. This must be done within 120 days from the date of Notice of Appeal Resolution you received from us. Please use the From Date Institutional Statement Date. If you file a grievance or an appeal, we must be fair. 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 of South Carolina will be known as Absolute Total Care as of April 1, 2021. UnitedHealthcare Dual Complete Special Needs Plan UnitedHealthcare Dual Complete Special Needs Plans (SNP) offer benefits for people with both Medicare and Medicaid. To do this: Be sure to ask us to continue your benefits within the 10 calendar day time frame. Examples of good cause include, but are not limited to, the following: We will send you a letter within five business days of getting your appeal. If you need claim filing assistance, please contact your provider advocate. The onlineProvider Manual represents the most up-to-date information on Wellcare Prime by Absolute Total Care (Medicare-Medicaid Plan), programs, policies, and procedures. WellCare credentialing cycles will be shared with Absolute Total Care in order to reduce duplicative credentialing in the future. 8h} \x p`03 1z`@+`~70 G ~Ws5Puick79,4 ,O5@?O-Gr'|5Oj:v6/` 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. Wellcare uses cookies. Send your written appeal to: We must have your written consent before someone can file an appeal for you. Can I continue to see my current WellCare members? Providers can help facilitate timely claim payment by having an understanding of our processes and requirements. Where should I submit claims for WellCare Medicaid members that transition to Absolute Total Care? 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. This manual sets forth the policies and procedures that providers participating in the Absolute Total Carenetwork are required tofollow. DOSApril 1, 2021 and after: Processed by Absolute Total Care. 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. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. The state has also helped to set the rules for making a grievance. Obstetrician care provided by an out of network Obstetrician will be covered for pregnant members inclusive of post-partum care. Please Explore the Site and Get To Know Us. Addakam ditoy para kenka. Download the free version of Adobe Reader. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. WellCare of South Carolina will be known as Absolute Total Care as of April 1, 2021. A. 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? You must ask within 30 calendar days of getting our decision. You can file the grievance yourself. If Medicare is the primary payer, timely filing is determined from the processing date indicated on the primary carrier's explanation of benefit (EOB) If Medicare is the Secondary Payer (MSP), the initial claim must be submitted to the primary payer within Cigna's timely filing period. You can file your appeal by calling or writing to us. DOS April 1, 2021 and after: Processed by Absolute Total Care. A. WellCare credentialing cycles will be shared with Absolute Total Care in order to reduce duplicative credentialing in the future. Providers are encouraged to visit the Provider Resources webpagefor manuals, forms, and resources related to claims submission, eligibility, prior authorization, and more. With the completion of this transaction, we have created a premier healthcare enterprise focused on government-sponsored healthcare programs. Copyright 2023 Wellcare Health Plans, Inc. 0 North Carolina PHP Billing Guidance for Local W Code. z4M0(th`1Lf`M18c BIcJ[%4l JU2 _ s * Password. The annual flu vaccine helps prevent the flu.Protect yourself and those around you. How are WellCare Medicaid member authorizations being handled after April 1, 2021? The participating provider agreement with WellCare will remain in-place after 4/1/2021. We will do this as quickly as possible as but no longer than 72-hours from the decision. Where should I submit claims for WellCare Medicaid members? By continuing to use our site, you agree to our Privacy Policy and Terms of Use. Resources We expect this process to be seamless for our valued members, and there will be no break in their coverage. 1,flQ*!WLOmsmz\D;I5BI,yA#z!vYQi5'fedREF40 b666q1(UtUJJ.i` (T/@E You or your authorized representative will tell the hearing officer why you think we made the wrong decision. Claims will be processed according to timely filing provisions in the providers WellCare Participating Provider Agreement. L]4(f4/pn~YTZSp-5/O*F)e~p:a6o{x8r The materials located on our website are for dates of service prior to April 1, 2021. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. 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. How do I join Absolute Total Cares provider network? We expect this process to be seamless for our valued members and there will be no break in their coverage. The timely filing limit is the time duration from service rendered to patients and submitting claims to the insurance companies. If at any time you need help filing one, call us. Timely filing limits vary. Will Absolute Total Care continue to offer Medicare and Marketplace products? To do so by phone, call Member Services at 1-888-588-9842 (TTY1-877-247-6272). Claims Department WellCare understands that having access to the right tools can help you and your staff streamline day-to-day administrative tasks. Payments mailed to providers are subject to USPS mailing timeframes. Division of Appeals and Hearings Q. 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. 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. 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. Contact Absolute Total Care Provider Service at1-866-433-6041if youhave questions. It is 30 days to 1 year and more and depends on . How do I determine if a professional or an outpatient bill type institutional submission should be filed to WellCare or Absolute Total Care? A. Download the free version of Adobe Reader. That's why we provide tools and resources to help. Absolute Total Care will utilize credentialing cycles from WellCare and Absolute Total Care so that providers will only need to credential once every three years. WellCare is the health care plan that puts you in control. Your second-level review will be performed by person(s) not involved in the first review. We expect this process to be seamless for our valued members, and there will be no break in their coverage. Please note - a representative may file for a member who: If the members request for appeal is submitted after 60 calendar days from the date on the NABD, then good cause must be shown in order for WellCare to accept the late request. 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. Please contact our Provider Services Call Center at 1-888-898-7969.