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For dates of service on or after 4/1/2021: Professional and Institutional Fee-For-Service/Encounter EDI transactions should be submitted to Absolute Total Care Medicaid with Payer ID <68069> for Emdeon/WebMD/Payerpath or <4272> for Relay Health/McKesson. Please contact our Provider Services Call Center at 1-888-898-7969. More Information Coronavirus (COVID-19) If an authorization is needed, you can log in to the Secure Provider Portal at absolutetotalcare.com to submit and confirm authorizations. Federal Employee Program (FEP) Federal Employee Program P.O. First Choice can accept claim submissions via paper or electronically (EDI). Q. Q. Select Health Claims must be filed within 12 months from the date of service. 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? It was a smart move. We try to make filing claims with us as easy as possible. Providers FAQs | Wellcare Timely Filing Limit: Timely Filing Limit is the time frame set by insurance companies and provider has to submit health care claims to respective insurance company within the set time frame for reimbursement of the claims. Providers are encouraged to visit the Provider Resources webpagefor manuals, forms, and resources related to claims submission, eligibility, prior authorization, and more. Explains how to receive, load and send 834 EDI files for member information. Member Sign-In. Attn: Grievance Department Managed Care Claims and Prior Authorizations Submission - NCDHHS Yes, Absolute Total Care and WellCare will continue to offer Medicare products under their current brands and product names, until further notice. Beginning, March 14 March 31, 2021, please send to WellCare, April 1 April 3, 2021, please send to Absolute Total Care, DOS prior to 4/1/2021- Processed by WellCare, DOS 4/1/2021 and after- Processed by Absolute Total Care, Date of Occurrence/DOS prior to 4/1/2021- Processed by WellCare, Date of Occurrence/DOS 4/1/2021 and after- Processed by Absolute Total Care. Wellcare uses cookies. However, there will be no members accessing/assigned to the Medicaid portion of the agreement. 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. Tampa, FL 33631-3372. To do so by phone, call Member Services at 1-888-588-9842 (TTY1-877-247-6272). Contact Wellcare Prime Provider Service at1-855-735-4398if youhave questions. Ancillary Claims Filing Reminders; ClaimsXten TM: Correct Coding Initiative Reference Guide; Inpatient Non-Reimbursable Charges/Unbundling Policy The state has also helped to set the rules for making a grievance. Members will need to talk to their provider right away if they want to keep seeing him/her. With the completion of this transaction, we have created a premier healthcare enterprise focused on government-sponsored healthcare programs. Wellcare wants to ensure that claims are handled as efficiently as possible. Members must have Medicaid to enroll. Providers can begin requesting prior authorization from Absolute Total Care for dates of service on or after April 1, 2021 from Absolute Total Care on March 15, 2021. WellCare has partnered with Change Healthcare as our preferred EDI Clearinghouse. WellCare understands that having access to the right tools can help you and your staff streamline day-to-day administrative tasks. Timely Filing Limit of Insurances - Revenue Cycle Management Professional and Institutional Fee-For-Service EDI transactions should be submitted to WellCare of South Carolina Medicaid with Payer ID 14163. All billing requirements must be adher ed to by the provider in order to ensure timely processing of claims. 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. From Date Institutional Statement Dates on or after April 1, 2021 should be filed to Absolute Total Care. An authorized representative is someone you select to act on the behalf of a member to assist them through the appeals process. $8v + Yu @bAD`K@8m.`:DPeV @l 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 . * Username. #~0 I Reimbursement Policies 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. Where should I submit claims for WellCare Medicaid members? In this section, we will explain how you can tell us about these concerns/grievances. Providers interested in joining the Absolute Total Care provider network should submit a request to the Network Development and Contracting Department via email at [email protected]. A. 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. 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. 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 annual flu vaccine helps prevent the flu. For dates of service prior to April 1, 2021: All paper claim submissions can be mailed to: WellCare Health Plans How are WellCare Medicaid member authorizations being handled 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. 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. 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. Farmington, MO 63640-3821. What is the Rx BIN and Group Number for WellCare members transitioning to Absolute Total Care on April 1, 2021? Pregnant members receiving care from an out-of-network Obstetrician can continue to see their current obstetrician until after the baby is born. Explains how to receive, load and send 834 EDI files for member information. S< For current information, visit the Absolute Total Care website. Pharmacy services prior to April 1, 2021 must be requested from WellCare of South Carolina. From Date Institutional Statement Dates prior to 4/1/2021 should be filed to WellCare of South Carolina. For additional information, questions or concerns, please contact your local Provider Network Management Representative. A. The participating provider agreement with WellCare will remain in-place after 4/1/2021. This must be done within 120 days from the date of Notice of Appeal Resolution you received from us. Instructions on how to submit a corrected or voided claim. Written notice is not needed if your expedited appeal request is filed verbally. We will call you with our decision if we decide you need a fast appeal. Providers interested in joining the Absolute Total Care Provider Network should submit a request to Network Development and Contracting via email at [email protected]. You or your authorized representative will tell the hearing officer why you think we made the wrong decision. Kasapulam ti tulong? 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. The Medicare portion of the agreement will continue to function in its entirety as applicable. Claim Filing Manual - First Choice by Select Health of South Carolina Q. We expect this process to be seamless for our valued members and there will be no break in their coverage. HealthPlan - redirect.centene.com - Allwell Medicare Claims Submission, Correspondence and Contact Resources will stay the same for the Medicare line of business. Q. WellCare Medicare Advantage Claims must be filed within 180 calendar days from the date of service. Select your topic and plan and click "Chat Now!" to chat with a live agent! Copyright 2023 Wellcare Health Plans, Inc. Clinical Laboratory Improvement Amendments (CLIA). 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. This manual sets forth the policies and procedures that providers participating in the Wellcare Prime network are required tofollow. A. Columbia, SC 29202-8206. However, as of April 1, 2021, all WellCare of South Carolina Medicaid members will become Absolute Total Care members. How do I determine if an institutional inpatient bill type submission overlapping 4/1/2021 should be filed to WellCare or Absolute Total Care? Claims | Wellcare Your second-level review will be performed by person(s) not involved in the first review. A. WellCare Medicaid members migrating to Absolute Total Care will be assigned to their assigned WellCare Primary Care Physician (PCP) as if the PCP is in network with Absolute Total Care. 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. Professional and Institutional Fee-For-Service/Encounter EDI transactions should be submitted to Absolute Total Care Medicaid with Payer ID 68069 for Emdeon/WebMD/Payerpath or 4272 for Relay Health/McKesson. Please use WellCare Payor ID 14163. Claims - Wellcare NC Box 3050 B^E{h#XYQv;[ny3Hha1yx4v.sBy jWacQzyL.kHhwtQ~35!Rh#)p+sj31LcC)4*Z:IWIG@WTD- )n,! Absolute Total Care will honor those authorizations. Wellcare uses cookies. 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. You can file your appeal by calling or writing to us. 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. Providers do not need to do anything additional to provide services on or after April 1, 2021 if the provider is in network with both WellCare and Absolute Total Care. A. Please use the Earliest From Date. As of April 1, 2021, WellCare will no longer be a separate plan option offered by South Carolina Healthy Connections Choices. 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. 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. 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.