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We are proud to announce that WellCare is now part of the Centene Family. WellCare of South Carolina will be known as Absolute Total Care as of April 1, 2021. We expect this process to be seamless for our valued members and there will be no break in their coverage.

With the completion of this transaction, we have created a premier healthcare enterprise focused on government-sponsored healthcare programs. As of April 1, 2021, WellCare will no longer be a separate plan option offered by South Carolina Healthy Connections Choices.

WellCare Medicare members are not affected by this change. Claims Submission, Correspondence and Contact Resources will stay the same for the Medicare line of business. 

Transition Inquiry FAQs

Q. What happens after April 1, 2021?

A. As of April 1, 2021, all WellCare of South Carolina Medicaid members will become Absolute Total Care members.  All transitioning Medicaid members will receive a welcome packet and new ID card from Absolute Total Care in March 2021 and will use the Absolute Total Care ID card to get prescriptions and access health care services starting April 1, 2021.  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. 

Q. Can I continue to see my current WellCare members?

A. Members can continue to receive services from their current WellCare provider as long as they remain covered under WellCare. However, as of April 1, 2021, all WellCare of South Carolina Medicaid members will become Absolute Total Care members.  Members will receive a 90-day transition of care period if the member is receiving ongoing care and treatment. 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 Care’s payment rates.

Pregnant members receiving care from an out of network Obstetrician can continue to see their current Obstetrician until after the baby is born. Obstetrician care provided by an out of network Obstetrician will be covered for pregnant members inclusive of post-partum care.

Q. How do I join Absolute Total Care’s provider network?

A. 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. Providers interested in joining the Absolute Total Care vision network for routine vision services can contact Envolve Vision at 1-800-531-2818.

Q. 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? 

A. 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. 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. Additionally, WellCare will have a migration section on their provider page at <https://wellcare.com/South-Carolina/WellCare-and-Absolute/Providers> publishing FAQs.

Q. What will happen to my Participating Provider Agreement with WellCare after 4/1/2021?

A. The participating provider agreement with WellCare will remain in-place after 4/1/2021.  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. 

Q. How will credentialing/recredentialing be handled by Absolute Total Care if a provider was recently credentialed/recredentialed by WellCare?

A. WellCare credentialing cycles will be shared with Absolute Total Care in order to reduce duplicative credentialing in the future. 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.

Q. Will my existing WellCare patients be assigned to my Absolute Total Care Panel?

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. All transitioning Medicaid members will receive a welcome packet and new ID card from Absolute Total Care in March 2021 and will use the Absolute Total Care ID card to get prescriptions and access health care services starting April 1, 2021.  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.   

Q: What is Absolute Total Care’s Transition/Continuity of Care Policy?

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. 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. 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.  This gives members time to establish with a new provider in the network and ensure that they have continuity of care. The member will be encouraged to establish care with a new in network PCP/specialist prior to the end of the transition/continuity of care period to review present treatment plan and coordinate the member's medical care.

  • 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. Members will need to talk to their provider right away if they want to keep seeing him/her. The provider needs to contact Absolute Total Care to arrange continuing care.
  • Absolute Total Care will honor all existing WellCare authorization approvals that include dates of service beyond March 31, 2021. Beginning March 15, 2021, providers can contact Absolute Total Care by phone, fax or secure portal for authorization if services will be provided on or after April 1, 2021. 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. 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. 

Q. How are WellCare Medicaid member authorizations being handled after April 1, 2021?

A. Prior authorizations issued by WellCare for dates of service on or after 4/1/2021 will transfer with the member’s eligibility to Absolute Total Care. Absolute Total Care will honor those authorizations. 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.

Q. 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?

A. 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.  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. If an authorization is needed, you can log in to the Secure Provider Portal at absolutetotalcare.com to submit and confirm authorizations.

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. Pharmacy services prior to 4/1/2021 must be requested from WellCare South Carolina. 

Q. What is the Rx BIN and Group Number for WellCare members transitioning to Absolute Total Care on April 1, 2021?

A.           RXBIN: 004336

      RXPCN: MCAIDADV

      RXGROUP: RX5433

Q. What will happen to unresolved claims prior to the membership transfer?

A. 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. WellCare claims will be processed according to timely filing provisions in the provider’s WellCare Participating Provider Agreement.

Q. Where should I submit claims for WellCare Medicaid members?

A. 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. Claims for services prior to April 1, 2021 should be filed to WellCare for processing. Claims will be processed according to timely filing provisions in the provider’s WellCare Participating Provider Agreement.

For dates of service prior to 4/1/2021:

Professional and Institutional Fee-For-Service EDI transactions should be submitted to WellCare of South Carolina Medicaid with Payer ID 14163.

Professional and Institutional Encounter EDI transactions should be submitted to WellCare of South Carolina Medicaid with Payer ID 59354.

All Paper Claim Submissions can be mailed to:

WellCare Health Plans
Claims Department
P.O. Box 31224
Tampa, FL 33631-3372

PROVIDER REMINDER: It is important that providers check eligibility prior to providing services as members can potentially change plans prior to 4/1/2021 if they are in the annual choice period.

Q. Where should I submit claims for WellCare Medicaid members that transition to Absolute Total Care?

A. Claims for services on or after April 1, 2021 should be filed to Absolute Total Care for processing. Claims will be processed according to timely filing provisions in the provider’s Absolute Total Care Participating Provider Agreement.

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.

All Paper Claim Submissions can be mailed to:

Absolute Total Care
P.O. Box 3050
Farmington, MO 63640-3821

PROVIDER REMINDER: It is important that providers check eligibility prior to providing services as members can potentially change plans prior to 4/1/2021 if they are in the annual choice period.

Q. How do I determine if an institutional inpatient bill type submission overlapping 4/1/2021 should be filed to WellCare or Absolute Total Care?

A. Please use the From Date Institutional Statement Date. From Date Institutional Statement Dates prior to 4/1/2021 should be filed to WellCare of South Carolina. From Date Institutional Statement Dates on or after 4/1/2021 should be filed to Absolute Total Care.

Examples:          If Statement Range is March 14, 2021 through April 3, 2021, please send to WellCare.

  If Statement Range is April 2, 2021 through April 10, 2021, please send to Absolute Total Care.

Q. How do I determine if a professional or an outpatient bill type institutional submission should be filed to WellCare or Absolute Total Care?

A. Please use the earliest From Date. Earliest From Dates prior to 4/1/2021 should be filed to WellCare of South Carolina. Earliest From Dates on or after 4/1/2021 should be filed to Absolute Total Care.

Examples:          If Statement Range is March 14, 2021 through April 3, 2021, please send to WellCare.

  If Statement Range is April 2, 2021 through April 10, 2021, please send to Absolute Total Care.

Q. How do I bill a professional submission with services spanning before and after 04/01/2021?

A. To avoid rejections please split the services into two separate claim submissions. All dates of service prior to 4/1/2021 should be filed to WellCare of South Carolina. All dates of service on or after 4/1/2021 should be filed to Absolute Total Care.

Example of how to properly split claim that span the cutover date of April 1, 2021:

  • March 14 – March 31, 2021, please send to WellCare
  • April 1 – April 3, 2021, please send to Absolute Total Care

Q. Will Absolute Total Care continue to offer Medicare and Marketplace products?

A. Yes, Absolute Total Care and WellCare will continue to offer Medicare products under their current brands and product names, until further notice. Absolute Total Care will continue to offer Marketplace products under the Ambetter brand.

Q. Will Absolute Total Care change its name to WellCare?

A. No, Absolute Total Care will continue to operate under the Absolute Total Care name. The current transaction means that WellCare of South Carolina Medicaid members are transitioning to Absolute Total Care and will become Absolute Total Care members, effective April 1, 2021.

Q. Will WellCare continue to offer current products or Medicare only?

A. As of April 1, 2021, all WellCare of South Carolina Medicaid members will transfer to Absolute Total Care. WellCare and Absolute Total Care Medicare plans will continue to operate under current brands, product names and provider contracts, until further notice.

APPEALS, GRIEVANCES AND PROVIDER DISPUTES

Member Appeals (Medical, Behavioral Health, and Pharmacy):

  • DOS prior to 4/1/2021- Processed by WellCare
  • DOS 4/1/2021 and after- Processed by Absolute Total Care

Member Grievances:

  • 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

Provider Disputes-Medical Necessity:

  • DOS prior to 4/1/2021- Processed by WellCare
  • DOS 4/1/2021 and after- Processed by Absolute Total Care
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Y0070_WCM_42183E Last Updated On: 10/1/2019
Wellcare Medicare and PDP is getting a new look! Be on the lookout for changes in the coming months and know you can still count on the great coverage you’ve come to expect. Meet the New Wellcare. ×