wellcare of south carolina timely filing limit wellcare of south carolina timely filing limit

By continuing to use our site, you agree to our Privacy Policy and Terms of Use. WellCare and Absolute Total Care Medicare plans will continue to operate under current brands, product names and provider contracts, until further notice. As of April 1, 2021, WellCare will no longer be a separate plan option offered by South Carolina Healthy Connections Choices. Copyright 2023 Wellcare Health Plans, Inc. Clinical Laboratory Improvement Amendments (CLIA). They are called: State law allows you to make a grievance if you have any problems with us. 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. Q. Please be sure to use the correct line of business prior authorization form for prior authorization requests. However, there will be no members accessing/assigned to the Medicaid portion of the agreement. 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. Obstetrician care provided by an out-of-network obstetrician will be covered for pregnant members inclusive of postpartum care. 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 Notice of Non-Discrimination We comply with applicable Federal civil rights laws and do not discriminate on the basis of race, color, national origin, age, sex, or disability. This gives members time to establish with a new provider in the network and ensure that they have continuity of care. You will have a limited time to submit additional information for a fast appeal. If you dont agree with our appeal decision - and you've completed the appeal steps with our health plan - or, if our appeal decision was not made within the required timeframe (30-calendar days for standard appeals or 72 hours for fast appeals), you may request a State Fair Hearing. 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. Prior authorizations issued by WellCare for dates of service on or after April 1, 2021 will transfer with the members eligibility to Absolute Total Care. Addakam ditoy para kenka. The Claim Reconsideration process is an informal claim review, and is not a substitute for an appeal of a final agency decision. A. We will also send you a letter with our decision within 72 hours from receiving your appeal. A grievance is when you tell us about a concern you have with our plan. You now have access to a secure, quick way to electronically settle claims. If you need assistance with your appeal please call Absolute Total Care at 1-866-433-6041 (TTY: 711) and we will assist you in filing your appeal. To avoid rejections please split the services into two separate claim submissions. Wellcare uses cookies. 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. Thanka kaa yoa Tufrbeau ingsnh ngetfu South Caralaita nouMa mpvd. Date of Occurrence/DOSprior toApril 1, 2021: Processed by WellCare. A. Columbia, SC 29202-8206. 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. Additionally, WellCare will have a migration section on their provider webpage publishing FAQs. We will notify you orally and in writing. 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. How will credentialing/recredentialing be handled by Absolute Total Care if a provider was recently credentialed/recredentialed by WellCare? 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. 941w*)bF iLK\c;nF mhk} Wellcare uses cookies. 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. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. Q. Overview & Resources WellCare of North Carolina partners with providers to develop and deliver high-quality, cost-effective health care solutions. Wfu neebybfgnh bgWfulnybfgC South Carolina Medicaid Provider Resource Guide Thank you for being a star member of our provider team. Earliest From Dates prior to April 1, 2021 should be filed to WellCare of South Carolina. 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. You and the person you choose to represent you must sign the AOR form. If you think you might have been exposed, contact a doctor immediately. Claims for services on or after April 1, 2021 should be filed to Absolute Total Care for processing. #~0 I Q. Providers interested in joining the Absolute Total Care vision network for routine vision services can contact Envolve Vision at 1-800-531-2818. 8h} \x p`03 1z`@+`~70 G ~Ws5Puick79,4 ,O5@?O-Gr'|5Oj:v6/` We want to ensure that claims are handled as efficiently as possible. We are glad you joined our family! Providers interested in joining the Absolute Total Care Provider Network should submit a request to Network Development and Contracting via email at. Q. To do this: 837 Institutional Encounter 5010v Guide The hearing officer will decide whether our decision was right or wrong. Copyright 2023 Wellcare Health Plans, Inc. We try to make filing claims with us as easy as possible. This manual sets forth the policies and procedures that providers participating in the Absolute Total Carenetwork are required tofollow. 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. You must ask within 30 calendar days of getting our decision. Box 600601 Columbia, SC 29260. We expect this process to be seamless for our valued members, and there will be no break in their coverage. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. Within five business days of getting your grievance, we will mail you a letter. 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. Awagandakami You or your authorized representative can review the information we used to make our decision. As of April 1, 2021, all WellCare of South Carolina Medicaid members will transfer to Absolute Total Care. Utilize interactive health and wellness tools to help you manage conditions, improve your health and save money. We are proud to announce that WellCare is now part of the Centene Family. Incorrect forms will not be considered and may lead to further delays in processing prior authorization requests. 1071 0 obj <>/Filter/FlateDecode/ID[<87133B316ADA4BDD8B85BA48A489D34F>]/Index[1044 53]/Info 1043 0 R/Length 117/Prev 692690/Root 1045 0 R/Size 1097/Type/XRef/W[1 2 1]>>stream We are simplifying Medicare so you can choose and use an affordable local plan that will help you achieve your best possible health. Members can continue to receive services from their current WellCare provider as long as they remain covered under WellCare. 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. Box 3050 At the hearing, well explain why we made our decision. 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. 3) Coordination of Benefits. You can get many of your Coronavirus-related questions answered here. Please use the earliest From Date. Wellcare uses cookies. Instructions on how to submit a corrected or voided claim. The onlineProvider Manual represents the most up-to-date information on Wellcare Prime by Absolute Total Care (Medicare-Medicaid Plan), programs, policies, and procedures. Tampa, FL 33631-3384. For current information, visit the Absolute Total Care website. An authorized representative is someone you select to act on the behalf of a member to assist them through the appeals process. 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. 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. 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. Q. Additionally, WellCare will have a migration section on their provider page at publishing FAQs. Contact Wellcare Prime Provider Service at1-855-735-4398if youhave questions. Tampa, FL 33631-3372. We expect this process to be seamless for our valued members, and there will be no break in their coverage. Q. Reimbursement Policies Copyright 2023 WellCare Health Plans, Inc. WellCare Non-Emergency Medical Transportation (NEMT) Update, Provider Self-Service Quick Reference Guide (PDF), Provider Masters Level Proposed Rates (PDF), Member Advisory Committee (MAC) Member Flyer (PDF), Member Advisory Committee (MAC) - LTSS Member Flyer (PDF), Managed Care PHP Member PCP Change Request Form (PDF), Provider Referral Form: LTSS Request for PCS Assessment (PDF). Timely filing is when you file a claim within a payer-determined time limit. Federal Employee Program (FEP) Federal Employee Program P.O. Register now. All dates of service on or after 4/1/2021 should be filed to Absolute Total Care. For example, if a payer has a 90-day timely filing requirement, that means you need to submit the claim within 90 days of the date of service. 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. A. Download the free version of Adobe Reader. With the completion of this transaction, we have created a premier healthcare enterprise focused on government-sponsored healthcare programs. We will call you with our decision if we decide you need a fast appeal. Professional and Institutional Encounter EDI transactions should be submitted to WellCare of South Carolina Medicaid with Payer ID 59354. hbbd``b`$= $ A. All billing requirements must be adher ed to by the provider in order to ensure timely processing of claims. A. Will Absolute Total Care change its name to WellCare? UHC Community TFL - Timely filing Limit: 120 Days: Unitedhealthcare TFL - Timely filing Limit: Participating Providers: 90 days Non Participating Providers: 180 Days If its secondary payer: 90 days from date of Primary Explanation of Benefits Unitedhealthcare timely filing limit for appeals: 12 months from original claim determination Yes, Absolute Total Care and WellCare will continue to offer Medicare products under their current brands and product names, until further notice. WellCare offers participating providers EFT and ERA services at no charge through PaySpan Health. 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. Download the free version of Adobe Reader. \{-w{,xI202100$0*bZf ,X AayhP3pYla" e 3G& `eoT#@ *;d * Username. The provider needs to contact Absolute Total Care to arrange continuing care. Contact Wellcare Prime Provider Service at 1-855-735-4398 if you have questions. Payments mailed to providers are subject to USPS mailing timeframes. To do so by phone, call Member Services at 1-888-588-9842 (TTY1-877-247-6272). A. 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. Timely Filing Limit: Timely Filing Limit is the time frame set by insurance companies and provider has to submit health care claims to respective insurance company within the set time frame for reimbursement of the claims. WellCare of South Carolina will be known as Absolute Total Care as of April 1, 2021. Continuation of Benefits During the Appeals Process We will continue covering your medical services during your appeal request and State Fair Hearing if all of the following are meet. You can also have a video visit with a doctor using your phone or computer. Attn: Grievance Department Check out the Interoperability Page to learn more. You may file your second level grievance review within 30 days of receiving your grievance decision letter. 1044 0 obj <> endobj ?-}++lz;.0U(_I]:3O'~3-~%-JM We will do this as quickly as possible as but no longer than 72-hours from the decision. If an authorization is needed, you can log in to the Secure Provider Portalto submit and confirm authorizations. 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, 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. Timely Filing Beginning October 1, 2020, the Timely Filing submission requirements specified in each Provider's Meridian Medicare contract will be enforced. You or your provider must call or fax us to ask for a fast appeal. All Paper Claim Submissions can be mailed to: WellCare Health Plans By continuing to use our site, you agree to our Privacy Policy and Terms of Use. You and the person you choose to represent you must sign the AOR statement. Please see list of services that will require authorization during this time. How are WellCare Medicaid member authorizations being handled after April 1, 2021? What will happen to unresolved claims prior to the membership transfer? DOSApril 1, 2021 and after: Processed by Absolute Total Care. 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. To write us, send mail to: You can fax it too. However, as of April 1, 2021, all WellCare of South Carolina Medicaid members will become Absolute Total Care members. $8v + Yu @bAD`K@8m.`:DPeV @l Earliest From Dates on or after April 1, 2021 should be filed to Absolute Total Care. You can file a grievance by calling or writing to us. To avoid rejections please split the services into two separate claim submissions. For the death or injury of a member of the South Carolina National Guard, as provided for in Section 42-7-67, the time for filing a claim is two years after the accident or one year after the federal claim is finalized, whichever is later. Please make sure you ask your members for a copy of their Absolute Total Care and Healthy Connections Choices Medicaid ID cards before each visit. Here are some guides we created to help you with claims filing. DOS April 1, 2021 and after: Processed by Absolute Total Care. Please use WellCare Payor ID 14163. The onlineProvider Manual represents the most up-to-date information on Absolute Total Cares Medicaid Plan, programs, policies, and procedures. Those who attend the hearing include: You can also request to have your hearing over the phone. Q: What is Absolute Total Cares Transition/Continuity of Care Policy? Provider can't require members to appoint them as a condition of getting services. Professional and Institutional Encounter EDI transactions should be submitted to WellCare of South Carolina Medicaid with Payer ID 59354. WellCare credentialing cycles will be shared with Absolute Total Care in order to reduce duplicative credentialing in the future. Your second-level review will be performed by person(s) not involved in the first review. N .7$* P!70 *I;Rox3 ] LS~. Our toll-free fax number is 1-877-297-3112. Absolute Total Care will honor all existing WellCare authorization approvals that include dates of service beyond March 31, 2021. 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. WellCare of South Carolinawants to ensure that claims are handled as efficiently as possible. The hearing officer does not decide in your favor. 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. Date of Occurrence/DOSApril 1, 2021 and after: Processed by Absolute Total Care. What is the Rx BIN and Group Number for WellCare members transitioning to Absolute Total Care on April 1, 2021? Please contact our Provider Services Call Center at 1-888-898-7969. The participating provider agreement with WellCare will remain in-place after 4/1/2021. Written notice is not needed if your expedited appeal request is filed verbally. As of April 1, 2021, all WellCare of South Carolina Medicaid members will transfer to Absolute Total Care. 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. No, Absolute Total Care will continue to operate under the Absolute Total Care name. If Statement Range is April 2, 2021 through April 10, 2021, please send to Absolute Total Care. From Date Institutional Statement Dates on or after 4/1/2021 should be filed to Absolute Total Care. and Human Services A. Box 31224 2) Reconsideration or Claim disputes/Appeals. Claim Filing Manual - First Choice by Select Health of South Carolina Explains rules and state, line of business and CMS-specific regulations regarding 837P EDI transactions. With the completion of this transaction, we have created a premier healthcare enterprise focused on government-sponsored healthcare programs. For dates of service prior to April 1, 2021: All paper claim submissions can be mailed to: WellCare Health Plans A. Claims will be processed according to timely filing provisions in the providers Absolute Total Care Participating Provider Agreement. State Health Plan State Claims P.O. If Statement Range is April 2, 2021 through April 10, 2021, please send to Absolute Total Care. More Information Coronavirus (COVID-19) Division of Appeals and Hearings The second level review will follow the same process and procedure outlined for the initial review. Box 8206 Columbia, SC 29202-8206 Or call 1-800-763-9087. If you need claim filing assistance, please contact your provider advocate. Providers are encouraged to sign up to receive EFT payments to avoid any payment delays. Get an annual flu shot today. 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 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. You, your friend, a relative, legal counsel or other spokesperson who has your written consent may ask for a State Fair Hearing. If at any time you need help filing one, call us. The participating provider agreement with WellCare will remain in-place after April 1, 2021. However, as of April 1, 2021, all WellCare of South Carolina Medicaid members will become Absolute Total Care members. Exceptions to the one-year time limit: a) Medicare Cost Sharing Claims . The materials located on our website are for dates of service prior to April 1, 2021. Explains rules and state, line of business and CMS-specific regulations regarding 837I EDI transactions. With the completion of this transaction, we have created a premier healthcare enterprise focused on government-sponsored healthcare programs. Pharmacy services prior to 4/1/2021 must be requested from WellCare South Carolina. We have licensed clinicians available to speak with you and to connect you to the support you need to feel better. Guides Filing Claims with WellCare. Coronavirus Disease 2019 (COVID-19) causes respiratory illness in people and can spread from person to person. From Date Institutional Statement Dates prior to April 1, 2021 should be filed to WellCare of South Carolina. Claims for services on or after April 1, 2021 should be filed to Absolute Total Care for processing. Explains how to receive, load and send 834 EDI files for member information. What will happen to my Participating Provider Agreement with WellCare after 4/1/2021? We expect this process to be seamless for our valued members and there will be no break in their coverage. For standard requests, if you call in your appeal, you must follow up with a written, signed one, within thirty calendar days. 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. Claims submission, correspondence, and contact resources will stay the same for the Medicare line of business. To have someone represent you, you must complete an Appointment of Representative (AOR) form. 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. For dates of service on or after April 1, 2021: Absolute Total Care 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. A. endstream endobj startxref We comply with applicable Federal civil rights laws and do not discriminate on the basis of race, color, national origin, age, sex, or disability. 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. It is 30 days to 1 year and more and depends on . 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. 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. WellCare of North Carolina partners with providers to develop and deliver high-quality, cost-effective health care solutions. Pregnant members receiving care from an out of network Obstetrician can continue to see their current Obstetrician until after the baby is born. 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. If Statement Range is March 14, 2021 through April 3, 2021, please send to WellCare. Reconsideration or Claim Disputes/Appeals: An appeal is a request you can make when you do not agree with a decision we made about your care. WellCare Medicare members are not affected by this change. BlueCross BlueShield of South Carolina Piedmont Service Center P.O. South Carolina DEPARTMENT OF HEALTH AND HUMAN SERVICES Post Office Box 8206 Columbia, South Carolina 29202-8206 www.scdhhs.gov November 24, 2009 ALL . 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).