Integration FAQs

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 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. 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.    

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 postpartum care.

Providers interested in joining the Absolute Total Care provider network should submit a request to the Network Development and Contracting Department 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.

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. Providers are encouraged to visit the Provider Resources webpage for manuals, forms, and resources related to claims submission, eligibility, prior authorization, and more.

Additionally, WellCare will have a migration section on their provider webpage publishing FAQs.

The participating provider agreement with WellCare will remain in-place after April 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. 

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 recredential once every three years.

WellCare Medicaid members migrating to Absolute Total Care will be assigned to their assigned WellCare primary care provider as if the primary care provider 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 healthcare 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.    

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 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.

• 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 the Secure Provider 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. 

Prior authorizations issued by WellCare for dates of service on or after April 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.

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. We encourage you to check the Medicaid Pre-Auth Check Tool to ensure that you are accessing the most current Absolute Total Care authorization requirements for dates of service on or after April 1, 2021. If an authorization is needed, you can log in to the Secure Provider Portal 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 April 1, 2021 from Absolute Total Care on April 1, 2021. Pharmacy services prior to April 1, 2021 must be requested from WellCare of South Carolina. 

• RXBIN: 004336
• RXPCN: MCAIDADV
• RXGROUP: RX5433

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.

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 April 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

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

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 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.

All paper claim submissions can be mailed to:

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

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

Please use the From Date Institutional Statement Date. From Date Institutional Statement Dates prior to April 1, 2021 should be filed to WellCare of South Carolina. From Date Institutional Statement Dates on or after April 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.

Please use the Earliest From Date. Earliest From Dates prior to April 1, 2021 should be filed to WellCare of South Carolina. Earliest From Dates on or after April 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.

To avoid rejections please split the services into two separate claim submissions. All dates of service prior to April 1, 2021 should be filed to WellCare of South Carolina. All dates of service on or after April 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.

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.

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.

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.

Providers will continue to follow WellCare’s Medicaid policies and procedures for services provided to WellCare Medicaid members for dates of service prior to April 1, 2021. Providers will follow Absolute Total Care Medicaid policies and procedures for all services, inclusive of medical, behavioral, and pharmaceutical benefits, provided to WellCare Medicaid members transitioning to Absolute Total Care for dates of service on or after April 1, 2021.

Providers are encouraged to visit the Provider Resources webpage for manuals, forms, clinical policies, payment policies, provider news and resources related to claims submission, eligibility, prior authorization and more.