R 1/70.3/Determining End Date of Timely Filing Period -- Receipt Date R 1/70.4/Determination of Untimely Filing and Resulting Actions R 1/70.5/Application to Special Claim Types R 1/70.6/Filing Claim Where General Time Limit Has Expired R 1/70.7/Exceptions Allowing Extension of Time Limit R 1/70.7.1/Administrative Error Box 8206 Columbia, SC 29202-8206 Or call 1-800-763-9087. The participating provider agreement with WellCare will remain in-place after April 1, 2021. 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. Claims Department 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. 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. As of April 1, 2021, all WellCare of South Carolina Medicaid members will become Absolute Total Care members. WellCare claims will be processed according to timely filing provisions in the providers WellCare Participating Provider Agreement. 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. We will send you another letter with our decision within 90 days or sooner. The hearing officer will decide whether our decision was right or wrong. 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. You can ask in writing for a State Fair Hearing (hearing, for short). 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. Q. You can get many of your Coronavirus-related questions answered here. A. Exceptions to the one-year time limit: a) Medicare Cost Sharing Claims . Filing an Appeal | South Carolina Medicaid | Absolute Total Care As of April 1, 2021, all WellCare of South Carolina Medicaid members will become Absolute Total Care members. Obstetrician care provided by an out-of-network obstetrician will be covered for pregnant members inclusive of postpartum care. Code of Laws - Title 42 - South Carolina General Assembly 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 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. PROVIDERS NOTE:Please send Corrected Claims as normal submissions via electronic or paper. 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.

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