Contact Wellcare Prime Provider Service at 1-85 if you have questions. including name of the billed party (i.e., IEHP, Capitated Provider, Medicare, HMO, etc.). This manual sets forth the policies and procedures that providers participating in the Wellcare Prime network are required to follow. The online Provider Manual represents the most up-to-date information on Wellcare Prime by Absolute Total Care (Medicare-Medicaid Plan), programs, policies, and procedures. SUMMARY OF CHANGES: Section 6404 of the Patient Protection and Affordable Care Act (the Affordable Care Act) reduced the maximum period for submission of all Medicare fee-for-service claims to no more than 12 months, or 1 calendar year, after the date of service. Medicare-Medicaid Provider Manual (PDF).Provider Portal Enhancements: Claim Reconsideration and Denial Explanations (PDF).Obstetrical (OB) Incentive Programs (PDF).Claim Adjustments, Reconsiderations, and Disputes Provider Education (PDF).Practitioner Credentialing Rights (PDF).Sick and Well Visit Reimbursement Letter (PDF).South Carolina Medicaid Bulletins (PDF).Grievance and Appeals Forms **Will open into a new window Behavioral Health Forms ** Will open into a new window Resources Medicare and individual claims for Medicare coverage and payment. SCDHHS Certificate of Medical Necessity (CMN) for Oxygen (PDF) 240 - Time Limits for Filing Appeals & Good Cause for Extension of the Time Limit for Filing Appeals 240.1 - Good Cause 240.2 - Conditions and Examples That May Establish Good Cause for Late Filing by Beneficiaries.Outpatient Prior Authorization Fax Form (PDF).Inpatient Prior Authorization Fax Form (PDF).SCDHHS Hospice Election/Enrollment Forms (PDF).Member Appointment of Authorized Representative Form (PDF).Pharmacy Forms **Will open into a new window Case Management Forms SCDHHS Form 1716 - Request for Medicaid ID Number - Infant (PDF).Pregnancy Incentive Reimbursement Form (PDF) Beginning October 1, 2020, the Timely Filing submission requirements specified in each Providers Meridian Medicare contract will be enforced.Notification of Pregnancy (NOP) Provider Form (PDF).Shortened Notification of Pregnancy (NOP) Provider Form (PDF) Medicare claims must be filed to the MAC no later than 12 months, or 1 calendar year, from the date the services were furnished.Contact Absolute Total Care Provider Service at 1-86 if you have questions. This manual sets forth the policies and procedures that providers participating in the Absolute Total Care network are required to follow. The online Provider Manual represents the most up-to-date information on Absolute Total Care’s Medicaid Plan, programs, policies, and procedures.
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