Instructions on how to submit a corrected or voided claim. Q. You or your provider must call or fax us to ask for a fast appeal. 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. The hearing officer does not decide in your favor. Please Explore the Site and Get To Know Us. Or you can have someone file it for you. How are WellCare Medicaid member authorizations being handled after April 1, 2021? How do I determine if a professional or an outpatient bill type institutional submission should be filed to WellCare or Absolute Total Care? Want to receive your payments faster to improve cash flow? From Date Institutional Statement Dates prior to April 1, 2021 should be filed to WellCare of South Carolina. We have licensed clinicians available to speak with you and to connect you to the support you need to feel better. Examples of good cause include, but are not limited to, the following: We will send you a letter within five business days of getting your appeal. More Information Need help? Wellcare uses cookies. Register now at https://www.payspanhealth.com or contact PaySpan at providersupport@payspanhealth.com, or 877-331-7154. Search for primary care providers, hospitals, pharmacies, and more! Select your topic and plan and click "Chat Now!" to chat with a live agent! 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. This gives members time to establish with a new provider in the network and ensure that they have continuity of care. WellCare Medicare Advantage Claims must be filed within 180 calendar days from the date of service. The Claim Reconsideration process is an informal claim review, and is not a substitute for an appeal of a final agency decision. For dates of service prior to April 1, 2021: All paper claim submissions can be mailed to: WellCare Health Plans Tampa, FL 33631-3372. The benefit can be used to get more than 150 items - including vitamins, pain relievers, cold and allergy medicines, baby wipes, and diapers - at no cost . Paper Claim Submission Submit paper claims to: WellCare Health Plans Electronic Claim Submission To initiate electronic claims, both in-network and out-of-network providers should contact their practice management software vendor or EDI software vendor. You can file the grievance yourself. Box 31384 Pregnant members receiving care from an out-of-network Obstetrician can continue to see their current obstetrician until after the baby is born. WellCare is the health care plan that puts you in control. 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, Shortened Notification of Pregnancy (NOP) Provider Form (PDF), Notification of Pregnancy (NOP) Provider Form (PDF), Pregnancy Incentive Reimbursement Form (PDF), SCDHHS Form 1716 - Request for Medicaid ID Number - Infant (PDF), Member Appointment of Authorized Representative Form (PDF), SCDHHS Hospice Election/Enrollment Forms (PDF), Inpatient Prior Authorization Fax Form (PDF), Outpatient Prior Authorization Fax Form (PDF), SCDHHS Certificate of Medical Necessity (CMN) for Oxygen (PDF), Sick and Well Visit Reimbursement Letter (PDF), Claim Adjustments, Reconsiderations, and Disputes Provider Education (PDF), Obstetrical (OB) Incentive Programs (PDF), Provider Portal Enhancements: Claim Reconsideration and Denial Explanations (PDF), Outpatient Prior Authorization Form (PDF), Medicare Prescription Drug Coverage Determination Form (PDF), Authorization to Use and/or Disclose Health Information (PDF), Revocation of Authorization to Use and/or Disclose Health Information (PDF), Behavioral Health Psychological or Neuropsychological Testing Authorization Request Form (PDF), Electroconvulsive Therapy (ECT) Authorization Request Form (PDF), Behavioral Health Outpatient Treatment Request Form (PDF), Transitional Care Management Services Fact Sheet (PDF), Expedited Prior Authorization Request FAQ (PDF), Balance Billing Quick Reference Guide (PDF), 2021 Prior Authorization List Part B Appendix A (PDF), Bi-Annual Prior Authorization Update (PDF), 2021 Bi-Annual Prior Authorization Update Effective 8/1/21 (PDF), 2021 List of Covered Drugs (Formulary) Changes (PDF), New Century Health Implementation Notification (PDF), 2022 Wellcare by Allwell Provider Manual (PDF), Provider Reconsideration/Dispute Form (PDF), Behavioral Health Neuropsychological Testing Authorization Request Form (PDF), Behavioral Health Outpatient Treatement Request Form (PDF), Behavioral Health Electroconvulsive Therapy (ECT) Authorization Request Form (PDF), Electronic Funds Transfer (ETF) Features (PDF), 2021 List of Covered Drugs (Formulary) DSNP Changes (PDF), 2021 List of Covered Drugs (Formulary) HMO Changes (PDF). An appeal may be filed within 60 calendar days from the date on the Adverse Benefit Determination Notice. #~0 I A grievance is when you tell us about a concern you have with our plan. endstream endobj 1045 0 obj <>/Metadata 50 0 R/OpenAction 1046 0 R/Outlines 160 0 R/Pages 1042 0 R/StructTreeRoot 166 0 R/Type/Catalog/ViewerPreferences<>>> endobj 1046 0 obj <> endobj 1047 0 obj <>/Font<>/ProcSet[/PDF/Text/ImageC/ImageB/ImageI]/XObject<>>>/Rotate 0/StructParents 0/Tabs/S/TrimBox[0.0 0.0 612.0 792.0]/Type/Page>> endobj 1048 0 obj <>stream Please use the earliest From Date. 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. We want to ensure that claims are handled as efficiently as possible. As of April 1, 2021, all WellCare of South Carolina Medicaid members will transfer to Absolute Total Care. Shop or Enroll in a Plan Frequently Asked Questions Find a Doctor Download Digital ID Card Welcome Allwell Members! Q. Box 8206 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. Members must have Medicaid to enroll. Effective January 1, 2015 the South Carolina Department of Health and Human Services (SCDHHS) will implement a Claim Reconsideration Policy. Claims will be processed according to timely filing provisions in the providers Absolute Total Care Participating Provider Agreement. A. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. Box 31224 WellCare Medicare members are not affected by this change. WellCare offers participating providers EFT and ERA services at no charge through PaySpan Health. Only you or your authorizedrepresentative can ask for a State Fair Hearing. Forms. Box 6000 Greenville, SC 29606. All Paper Claim Submissions can be mailed to: WellCare Health Plans Click below for more information from Absolute Total Care: You are now able to view your health information from a third-party app on a mobile device or PC! These grievances may be about: The state of South Carolina allows members to file a grievance at anytime from the event that caused the dissatisfaction. N .7$* P!70 *I;Rox3 ] LS~. 941w*)bF iLK\c;nF mhk} You, your friend, a relative, legal counsel or other spokesperson who has your written consent may ask for a State Fair Hearing. Reimbursement Policies You will need Adobe Reader to open PDFs on this site. Q. In this section, we will explain how you can tell us about these concerns/grievances. Timely filing is when you file a claim within a payer-determined time limit. At the hearing, well explain why we made our decision. WellCare claims will be processed according to timely filing provisions in the providers WellCare Participating Provider Agreement. Providers can help facilitate timely claim payment by having an understanding of our processes and requirements. 2023 Medicare and PDP Compare Plans and Enroll Now. B^E{h#XYQv;[ny3Hha1yx4v.sBy jWacQzyL.kHhwtQ~35!Rh#)p+sj31LcC)4*Z:IWIG@WTD- )n,! Q. Wellcare Health Plans, Inc., complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Download the free version of Adobe Reader. Will Absolute Total Care change its name to WellCare? If you request a hearing, the request must: A State Fair Hearing is a legal proceeding. For the latest COVID-19 news, visit the CDC. For standard requests, if you call in your appeal, you must follow up with a written, signed one, within thirty calendar days. Member Appeals (Medical, Behavioral Health, and Pharmacy): Copyright 2023 Wellcare Health Plans, Inc. As of April 1, 2021, all WellCare of South Carolina Medicaid members will become Absolute Total Care members. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. 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. Will Absolute Total Care continue to offer Medicare and Marketplace products? P.O. Here are some guides we created to help you with claims filing. You can get many of your Coronavirus-related questions answered here. Explains how to receive, load and send 834 EDI files for member information. You will get a letter from us when any of these actions occur. We will notify you orally and in writing. 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. WellCare and Absolute Total Care Medicare plans will continue to operate under current brands, product names and provider contracts, until further notice. We may apply a 14 day extension to your grievance resolution. You can ask in writing for a State Fair Hearing (hearing, for short). 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. Living Well Quality of Care Medicaid Managed Care Medicaid and CHIP Quality Resource Library Improvement Initiatives Performance Measurement Releases & Announcements Enrollment Strategies Continuous Eligibility Express Lane Eligibility Lawfully Residing Immigrant Children & Pregnant Women Presumptive Eligibility Home & Community Based Services WellCare of North Carolina will begin to release medical payments to providers beginning July 6, 2021. Prior authorizations issued by WellCare for dates of service on or after 4/1/2021 will transfer with the members eligibility to Absolute Total Care. To avoid rejections please split the services into two separate claim submissions. Welcome to WellCare Provider Login Contact Us Join Our Network Medicaid Medicare Tools News and Education AcariaHealth Specialty Pharmacy Pharmacy Forms Request for Drug Coverage Request to Review Drug Coverage Denial . This must be done within 120 days from the date of Notice of Appeal Resolution you received from us. Example of how to properly split claim that span the cutover date of April 1, 2021: Yes, Absolute Total Care and WellCare will continue to offer Medicare products under their current brands and product names, until further notice. 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. 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. More Information Coronavirus (COVID-19) 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. 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. You can file your appeal by calling or writing to us. In South Carolina, WellCare and Absolute Total Care are joining to better serve you. Register now at https://www.payspanhealth.comor contact PaySpan at providersupport@payspanhealth.com, or 877-331-7154. We try to make filing claims with us as easy as possible. WellCare offers participating providers EFT and ERA services at no charge through PaySpan Health. If an authorization is needed, you can log in to the Secure Provider Portalto submit and confirm authorizations. We want you to let us know right away if you have any questions, grievances or problems with your covered services or the care you receive. A provider can act for a member in hearings with the member's written permission in advance. Division of Appeals and Hearings hbbd``b`$= $ You will need Adobe Reader to open PDFs on this site. If you ask for a fast appeal and we decide that one is not needed, we will: You or your authorized representative can give us more information if you think itll help your appeal (regular or fast). You can file a grievance by calling or writing to us. 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. A. 837 Institutional Encounter 5010v Guide and Human Services They must inform their vendor of AmeriHealth Caritas . You will have a limited time to submit additional information for a fast appeal. With the completion of this transaction, we have created a premier healthcare enterprise focused on government-sponsored healthcare programs. P.O. The provider needs to contact Absolute Total Care to arrange continuing care. Medicaid Claims Payment Policies We will do this as quickly as possible as but no longer than 72-hours from the decision. 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. Hearings are used when you were denied a service or only part of the service was approved. Section 1: General Information. Members will need to talk to their provider right away if they want to keep seeing him/her. The participating provider agreement with WellCare will remain in-place after 4/1/2021. To avoid rejections please split the services into two separate claim submissions. We expect this process to be seamless for our valued members and there will be no break in their coverage. For example, if any patient gets services on the 1st of any month then there is a time limit to submit his/her claim to the insurance company for reimbursement. Know the facts about Coronavirus (COVID-19) Our call centers, including the nurse advice line, are currently experiencing high volume. Earliest From Dates prior to 4/1/2021 should be filed to WellCare of South Carolina. Q: What is Absolute Total Cares Transition/Continuity of Care Policy? It was a smart move. We're here for you. 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. This manual sets forth the policies and procedures that providers participating in the Wellcare Prime network are required tofollow. That's why we provide tools and resources to help. Contact Wellcare Prime Provider Service at 1-855-735-4398 if you have questions. The annual flu vaccine helps prevent the flu. A hearing officer from the State will decide if we made the right decision. Box 3050 Go365 for Humana Healthy Horizons Members can register for the new Go365 for Humana Healthy Horizons wellness program and earn rewards for participating in healthy activities. $8v + Yu @bAD`K@8m.`:DPeV @l Members will receive a 90-day transition of care period if the member is receiving ongoing care and treatment. S< hYnH~}9'I`@>cLq,&DYH"W~&eJx'"luWU]JDBFRJ!*SN(s'6# ^*dg4$SB7K4z:r6')baka+Raf4J=)l, _/jaSpao69&&_Ln=?/{:,'z .1J0|~jv4[eUN{:-gl! K'&hng?y},&X/|OzcJ@0PhDiO})9RA9tG%=|rBhHBz7 You and the person you choose to represent you must sign the AOR statement. 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. %PDF-1.6 % A. To earn rewards, members must: Download the Go365 for Humana Healthy Horizons app onto a mobile device from the Apple App Store or Google Play. The Medicare portion of the agreement will continue to function in its entirety as applicable. endstream endobj startxref Additionally, WellCare will have a migration section on their provider page at publishing FAQs. The way your providers or others act or treat you. The participating provider agreement with WellCare will remain in-place after April 1, 2021. Timely Filing Limits for all Insurances updated (2023) - Bcbsproviderphonenumber Timely Filing Limits for all Insurances updated (2023) One of the common and popular denials is passed the timely filing limit. WellCare has partnered with Change Healthcare as our preferred EDI Clearinghouse. Contact Absolute Total Care Provider Service at1-866-433-6041if youhave questions. Wellcare wants to ensure that claims are handled as efficiently as possible. A. 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. However, there will be no members accessing/assigned to the Medicaid portion of the agreement. With the completion of this transaction, we have created a premier healthcare enterprise focused on government-sponsored healthcare programs. Need an account? You or your authorized representative can review the information we used to make our decision. Tampa, FL 33631-3384. We process check runs daily, with the exception of Sundays, National Holidays, and the last day of the month. People of all ages can be infected. Ambetter from Absolute Total Care - South Carolina. Members will need to talk to their provider right away if they want to keep seeing him/her. WellCare Medicaid members migrating to Absolute Total Care will be assigned to their assigned WellCare primary care provider as if the primary care provideris in network with Absolute Total Care. March 14-March 31, 2021, please send to WellCare. Our fax number is 1-866-201-0657. If you wish to use a representative, then he or she must complete an Appointment of Representative (AOR) statement. Claim Filing AmeriHealth Caritas North Carolina, hereafter referred to as the Plan (where appropriate), is required by the North Carolina and federal regulations to capture specific data regarding services rendered to its members. Check out the Interoperability Page to learn more. We would like to help your billing department get your EDI (claims and real time) transactions processed as efficiently as possible. 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. hb```b``6``e`~ "@1V NB, As of April 1, 2021, WellCare will no longer be a separate plan option offered by South Carolina Healthy Connections Choices. Written notice is not needed if your expedited appeal request is filed verbally. Download the free version of Adobe Reader. A. Claims for services on or after April 1, 2021 should be filed to Absolute Total Care for processing. 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. You do not appeal within 10 calendar days from when the Plan mails an adverse Notice of Action, or you do not request a hearing within 10 calendar days from when the Plan mails an adverse Notice of Appeals Resolution whichever is later. Exceptions to the one-year time limit: a) Medicare Cost Sharing Claims . 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. Those who attend the hearing include: You can also request to have your hearing over the phone. Claims for services on or after April 1, 2021 should be filed to Absolute Total Care for processing. 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. The onlineProvider Manual represents the most up-to-date information on Wellcare Prime by Absolute Total Care (Medicare-Medicaid Plan), programs, policies, and procedures. Absolute Total Care will continue to offer Marketplace products under the Ambetter brand. Explains rules and state, line of business and CMS-specific regulations regarding 837P EDI transactions. WellCare claims will be processed according to timely filing provisions in the providers WellCare Participating Provider Agreement. We will continue covering your medical services during your appeal request and State Fair Hearing if all of the following are meet. Pregnant members receiving care from an out of network Obstetrician can continue to see their current Obstetrician until after the baby is born. 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. Awagandakami Electronic and Paper Claims Submissions; Institutional Claims/Encounter Guides. Absolute Total Care will honor all existing WellCare authorization approvals that include dates of service beyond March 31, 2021. Outpatient Prior Authorization Form (PDF) Inpatient Prior Authorization Form (PDF) Payments mailed to providers are subject to USPS mailing timeframes. Q. The provider needs to contact Absolute Total Care to arrange continuing care. You can make three types of grievances. WellCare of South Carolina will be known as Absolute Total Care as of April 1, 2021. Claims Department A. WellCare credentialing cycles will be shared with Absolute Total Care in order to reduce duplicative credentialing in the future. You can get many of your Coronavirus-related questions answered here. 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. Explains rules and state, line of business and CMS-specific regulations regarding 837I EDI transactions. Where should I submit claims for WellCare Medicaid members that transition to Absolute Total Care? We will call you with our decision if we decide you need a fast appeal. 2) Reconsideration or Claim disputes/Appeals. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. Q. To do this: Be sure to ask us to continue your benefits within the 10 calendar day time frame. 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. If your services are continued during an appeal or a hearing, you can keep getting them until: If the hearing is decided in your favor, well approve and pay for the care that is needed. 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. 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. A. you have another option. State Health Plan State Claims P.O. 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. An authorized representative is someone you select to act on the behalf of a member to assist them through the appeals process. DOSApril 1, 2021 and after: Processed by Absolute Total Care. UnitedHealthcare Dual Complete Special Needs Plan UnitedHealthcare Dual Complete Special Needs Plans (SNP) offer benefits for people with both Medicare and Medicaid. DOS prior toApril 1, 2021: Processed by WellCare. For general questions about claims submissions, call Provider Claims Services at 1-800-575-0418. Timely filing limits vary. Or it can be made if we take too long to make a care decision. Register now. Q. A. %%EOF Initial Claims: 120 Days from the Date of Service. 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. Obstetrician care provided by an out of network Obstetrician will be covered for pregnant members inclusive of post-partum care. Box 8206 Columbia, SC 29202-8206 Or call 1-800-763-9087. For current information, visit the Absolute Total Care website. Wellcare uses cookies. Absolute Total Care will honor all existing WellCare authorization approvals that include dates of service beyond March 31, 2021. South Carolina Department of Health and Human Services Division of Appeals and Hearings P.O. If Medicare is the primary payer, timely filing is determined from the processing date indicated on the primary carrier's explanation of benefit (EOB) If Medicare is the Secondary Payer (MSP), the initial claim must be submitted to the primary payer within Cigna's timely filing period. No, Absolute Total Care will continue to operate under the Absolute Total Care name. The Medicare portion of the agreement will continue to function in its entirety as applicable. Absolute Total Care Providers are encouraged to visit the Provider Resources webpageformanuals, forms, clinical policies, payment policies, provider news and resources related to claims submission, eligibility, prior authorization and more. Explains how to receive, load and send 834 EDI files for member information. APPEALS, GRIEVANCES AND PROVIDER DISPUTES. Members can continue to receive services from their current WellCare provider as long as they remain covered under WellCare. Call us to get this form. To ask for hearing, call 1-800-763-9087 or write to: You also can make a request online using SCDHHS form at https://msp.scdhhs.gov/appeals/site-page/file-appeal. pst/!+ Y^Ynwb7tw,eI^