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By continuing to use our site, you agree to our Privacy Policy and Terms of Use. Instructions on how to submit a corrected or voided claim. Additionally, WellCare will have a migration section on their provider page at publishing FAQs. Claims for services on or after April 1, 2021 should be filed to Absolute Total Care for processing. WellCare understands that having access to the right tools can help you and your staff streamline day-to-day administrative tasks. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. Appeals and Grievances | Wellcare 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. Pharmacy services prior to April 1, 2021 must be requested from WellCare of South Carolina. Providers FAQs | Wellcare Molina Healthcare of Michigan, 100 W. Big Beaver Road, Suite 600 Attn: Claims, Troy, MI 48084-5209 Or Fax to: (248) 925-1768. Claims will be processed according to timely filing provisions in the providers WellCare Participating Provider Agreement. To have someone represent you, you must complete an Appointment of Representative (AOR) form. It can also be about a provider and/or a service. P.O. They are called: State law allows you to make a grievance if you have any problems with us. This manual sets forth the policies and procedures that providers participating in the Wellcare Prime network are required to follow. 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. Electronic and Paper Claims Submissions; Institutional Claims/Encounter Guides. 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. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. For dates of service prior to April 1, 2021: All paper claim submissions can be mailed to: WellCare Health Plans Explains rules and state, line of business and CMS-specific regulations regarding 837I EDI transactions. 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. Managed Care Claims and Prior Authorizations Submission - NCDHHS Providers can begin requesting prior authorization for pharmacy services from Absolute Total Care for dates of service on or after 4/1/2021 from Absolute Total Care on April 1, 2021. Providers interested in joining the Absolute Total Care Provider Network should submit a request to Network Development and Contracting via email at. 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. Visit https://msp.scdhhs.gov/appeals/ to: Copyright 2023 Wellcare Health Plans, Inc. https://msp.scdhhs.gov/appeals/site-page/file-appeal, If we deny or limit a service you or your doctor asks us to approve, If we reduce, suspend or stop services youve been getting that we already approved, If we do not pay for the health care services you get, If we fail to give services in the required timeframe, If we fail to give you a decision in the required timeframe on an appeal you already filed, If we dont agree to let you see a doctor who is not in our network and you live in a rural area or in an area with limited doctors, If you dont agree with a decision we made regarding your medicine, We denied your request to dispute a financial liability, The member did not personally receive the notice of action or received the notice late, The member was seriously ill, which prevented a timely appeal, There was a death or serious illness in the members immediate family, An accident caused important records to be destroyed, Documentation was difficult to locate within the time limits; and/or the member had incorrect or incomplete information concerning the appeals process, Change the appeal to the timeframe for a standard decision (30 calendar days), Follow up with a written letter within 2 calendar days, Tell you over the phone and in writing that you may file a grievance about the denial of the fast appeal request, Be in writing and specify the reason for the request, Include your name, address and phone number, Indicate the date of service or the type of service denied, Your authorized representative (if youve chosen one), A hearing officer from Medicaid and Long-Term Care (MLTC), You or your authorized representative with your written consent must file your appeal with us and ask to continue your benefits within 10 calendar days after we mail the Notice of Adverse benefit determination; or, Within 10 calendar days of the intended effective date of the plans proposed action, whichever is later, The appeal or hearing must address the reduction, suspension or stopping of a previously authorized service, The services were ordered by an authorized provider, The period covered by the original authorization cannot have ended. For standard requests, if you call in your appeal, you must follow up with a written, signed one, within thirty calendar days. WellCare of South Carolina will be known as Absolute Total Care as of April 1, 2021. With the completion of this transaction, we have created a premier healthcare enterprise focused on government-sponsored healthcare programs. Professional and Institutional Fee-For-Service EDI transactions should be submitted to WellCare of South Carolina Medicaid with Payer ID 14163. Members can continue to receive services from their current WellCare provider as long as they remain covered under WellCare. Reconsideration or Claim Disputes/Appeals: UnitedHealthcare Dual Complete Special Needs Plan UnitedHealthcare Dual Complete Special Needs Plans (SNP) offer benefits for people with both Medicare and Medicaid. Learn how you can help keep yourself and others healthy. To do this: Be sure to ask us to continue your benefits within the 10 calendar day time frame. From Date Institutional Statement Dates prior to April 1, 2021 should be filed to WellCare of South Carolina. An appeal is a request you can make when you do not agree with a decision we made about your care. 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. Written notice is not needed if your expedited appeal request is filed verbally. Members will need to talk to their provider right away if they want to keep seeing him/her. Providers can help facilitate timely claim payment by having an understanding of our processes and requirements. Hearings are used when you were denied a service or only part of the service was approved. Incorrect forms will not be considered and may lead to further delays in processing prior authorization requests. WellCare of North Carolina partners with providers to develop and deliver high-quality, cost-effective health care solutions. When can providers begin requesting prior authorization from Absolute Total Care for WellCare Medicaid members for dates of service on or after April 1, 2021? South Carolina | Medicaid 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. Providers interested in joining the Absolute Total Care Provider Network should submit a request to Network Development and Contracting via email at atc_contracting@centene.com. South Carolina Medicaid Provider Documents - Humana There is a lot of insurance that follows different time frames for claim submission. Can I continue to see my current WellCare members? Q. For the death or injury of a member of the South Carolina National Guard, as provided for in Section 42-7-67, the time for filing a claim is two years after the accident or one year after the federal claim is finalized, whichever is later. We encourage you to check the Medicaid Pre-Auth Check Tool in the For Providers section on the Absolute Total Care website at absolutetotalcare.com to ensure that you are accessing the most current Absolute Total Care authorization requirements for dates of service on or after 4/1/2021. Providers interested in joining the Absolute Total Care vision network for routine vision services can contact Envolve Vision at 1-800-531-2818. Professional and Institutional Encounter EDI transactions should be submitted to WellCare of South Carolina Medicaid with Payer ID 59354. 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. Keep yourself informed about Coronavirus (COVID-19.) 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. Contact Us Y0020_WCM_100876E Last Updated On: 10/1/2022 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 . Example of how to properly split claim that span the cutover date of April 1, 2021: Q. South Carolina Medicaid & Health Insurance | Absolute Total Care Explains rules and state, line of business and CMS-specific regulations regarding 837I EDI transactions.