Providers interested in joining the Absolute Total Care vision network for routine vision services can contact Envolve Vision at 1-800-531-2818. Box 3050 We are simplifying Medicare so you can choose and use an affordable local plan that will help you achieve your best possible health. For the latest COVID-19 news, visit the CDC. 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. Your second-level review will be performed by person(s) not involved in the first review. WellCare of South Carolina will be known as Absolute Total Care as of April 1, 2021. 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. 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. How will credentialing/recredentialing be handled by Absolute Total Care if a provider was recently credentialed/recredentialed by WellCare? and Human Services 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. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. Contact Wellcare Prime Provider Service at 1-855-735-4398 if you have questions. 1071 0 obj <>/Filter/FlateDecode/ID[<87133B316ADA4BDD8B85BA48A489D34F>]/Index[1044 53]/Info 1043 0 R/Length 117/Prev 692690/Root 1045 0 R/Size 1097/Type/XRef/W[1 2 1]>>stream Ambetter Timely Filing Limit of : 1) Initial Claims. If at any time you need help filing one, call us. 3) Coordination of Benefits. All dates of service on or after 4/1/2021 should be filed to Absolute Total Care. Farmington, MO 63640-3821. However, there will be no members accessing/assigned to the Medicaid portion of the agreement. Wellcare uses cookies. The hearing officer will decide whether our decision was right or wrong. The Medicare portion of the agreement will continue to function in its entirety as applicable. Addakam ditoy para kenka. Within five business days of getting your grievance, we will mail you a letter. Contact Us Y0020_WCM_100876E Last Updated On: 10/1/2022 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. 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. Or it can be made if we take too long to make a care decision. 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. An authorized representative is someone you select to act on the behalf of a member to assist them through the appeals process. We will also send you a letter with our decision within 72 hours from receiving your appeal. Date of Occurrence/DOSApril 1, 2021 and after: Processed by Absolute Total Care. As of April 1, 2021, all WellCare of South Carolina Medicaid members will become Absolute Total Care members. Register now. 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. All dates of service prior to 4/1/2021 should be filed to WellCare of South Carolina. Q. 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. You will get a letter from us when any of these actions occur. If you are unable to view PDFs, please download Adobe Reader. Will Absolute Total Care continue to offer Medicare and Marketplace products? P.O. 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. What will happen to my Participating Provider Agreement with WellCare after 4/1/2021? Pregnant members receiving care from an out-of-network Obstetrician can continue to see their current obstetrician until after the baby is born. Examples: If Statement Range is March 14, 2021 through April 3, 2021, please send to WellCare. 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. This manual sets forth the policies and procedures that providers participating in the Absolute Total Carenetwork are required tofollow. Providers interested in joining the Absolute Total Care vision network for routine vision services can contact Envolve Vision at 1-800-531-2818. Our call centers, including the nurse advice line, are currently experiencing high volume. Claims Submission, Correspondence and Contact Resources will stay the same for the Medicare line of business. 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. The rules include what we must do when we get a grievance. 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. Awagandakami Welcome to Wellcare By Allwell, a Medicare Advantage plan. A. 837 Institutional Encounter 5010v Guide How do I determine if an institutional inpatient bill type submission overlapping 4/1/2021 should be filed to WellCare or Absolute Total Care? The Medicare portion of the agreement will continue to function in its entirety as applicable. The onlineProvider Manual represents the most up-to-date information on Wellcare Prime by Absolute Total Care (Medicare-Medicaid Plan), programs, policies, and procedures. 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. Overview & Resources WellCare of North Carolina partners with providers to develop and deliver high-quality, cost-effective health care solutions. From Date Institutional Statement Dates prior to 4/1/2021 should be filed to WellCare of South Carolina. How do I join Absolute Total Cares provider network? Please use WellCare Payor ID 14163. You can ask in writing for a State Fair Hearing (hearing, for short). The provider needs to contact Absolute Total Care to arrange continuing care. Initial Claims: 120 Days from the Date of Service. Explains rules and state, line of business and CMS-specific regulations regarding 837I EDI transactions. Incorrect forms will not be considered and may lead to further delays in processing prior authorization requests. P.O. Absolute Total Care will honor those authorizations. We expect this process to be seamless for our valued members and there will be no break in their coverage. For dates of service prior to April 1, 2021: All paper claim submissions can be mailed to: WellCare Health Plans

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