ATC - WellCare Prime by ATC Quick Reference Guide

 

tracelogoRB Reference Guide for WellCare Prime by ATC (ATC                             Medicare/Medicaid Plan)

 

EFFECTIVE January 1, 2022, the ATC/Healthy Connections Prime plan will become WellCare Prime by Absolute Total Care. All information below applies to this plan. Importantly, all claims for this plan will continue to be submitted to HNS as ATC claims.

 

HNS' contract with ATC includes its Medicare/Medicaid managed care plan, WellCare Prime by ATC.

 

MA Plans are offered by various private companies (such as ATC, BCBS, United Healthcare, etc.) that have been approved by Medicare.

 

Individuals that join a Medicare Advantage Plan still have Medicare, but coverage is from the Medicare Advantage Plan and not original Medicare.

 

WellCare Prime by ATC covers the same chiropractic services covered by original Medicare. Just as with Medicare, please be sure to include the AT modifier as applicable.

 

This WellCare Prime by ATC Quick Reference Guide provides information specific to the WellCare Prime by ATC plan concerning claims, members, and policies.


 

General Information

 

Eligibility/Benefits

 

Prior Authorization

 

Referral System

 

Copayments

 

WellCare Prime by ATC ID Cards

 

Claims Submission

 

Claims Inquiries

 

Provider Relations

 

 


General Information

 

PLEASE REMEMBER:  Do not send claims directly to ATC!

 

Please ignore the claims billing address on the member ID card or any address given to you on the telephone when verifying eligibility and benefits. You are under contract as a participating ATC provider through HNS and our instructions for filing claims supersede information given to you by ATC Representatives!

 

With only a few exceptions, all claims for COVERED SERVICES provided to a beneficiary of an HNS contracted payor MUST be submitted to HNS.

 

If you have questions about ATC, please contact your HNS Service Representative before calling ATC. Your HNS Service Representative's email address is displayed on the provider dashboard on the secure section of the HNS website.

 

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Eligibility/Benefits

 

Be sure to ALWAYS verify eligibility for each ATC member!

 

To verify eligibility and benefits, refer to the telephone number on the member's identification card or call (855) 766-1497.

 

Please remember to ask for specific information on chiropractic benefits for each member. CLICK HERE to see a sample Verification of Eligibility/Benefits Form.

 

ATC has attached the HNS EIN to all HNS providers, so you MUST use the HNS TAX ID number (56-1971088) in order to receive in-network verification. (If you use your own EIN when verifying eligibility and benefits, you will be told that you are not listed as a participating provider.) 

 

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Prior Authorization

 

Prior authorization is NOT required for chiropractic manipulation for WellCare Prime by ATC members. 

 

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Referral System

 

Referrals from PCPs are NOT required. 

 

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Copayments

 

The WellCare Prime by ATC plan has a $0.00 copayment for chiropractic visits. 

 

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WellCare Prime by ATC ID Cards

 

All WellCare Prime by ATC claims must be submitted to HNS as ATC claims. Please remember to obtain a copy of the front and back of the insurance card and maintain this in the member's health care record.

 

 

 

Group Number

Group or policy number must be in box 11, or if the ID card does not have a group or policy number, please use the first three letters or numbers of the subscriber ID.

 

If you are uncertain about where to file the claim, please email your HNS Service Representative a clear, legible copy of the member ID card and we will promptly respond back to you with an answer. Your HNS Service Representative's email address is displayed on the provider dashboard on the secure section of the HNS website. 

 

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Claims Submission

 

All primary claims for WellCare Prime by ATC must be submitted to HNS through HNSConnect® as ATC claims.

 

If necessary to submit a claim via paper (primary, secondary, corrected claims or claims with attachments), ATC requires: 

  • The submission of the red and white CMS 1500 claim form. Copies of the form that do not show the red color will be denied.
  • That paper claims must be typed. They cannot be handwritten.

ATC will deny all paper claims which are not submitted via the red/white CMS 1500 claim form and/or which are handwritten (or which include ANY handwritten words on the claim.)

 

Corrected Claims:  CLICK HERE for information on filing corrected claims.

 

Ignore any instructions regarding where to submit claims by payor phone representatives. HNS instructions regarding where to submit claims supersede all other instructions given by payor representatives when verifying eligibility and benefits.

 

In order for WellCare Prime by ATC claims to adjudicate quickly and accurately, please note the following information regarding claims submission specific to ATC is in addition to the HNS Billing Guidelines. 

  • Group or policy number must be in box 11, or if the ID card does not have a group or policy number, please use the first three (3) letters or numbers of the subscriber ID.
  • HNS/ATC must be in box 11c.
  • Even when filing claims electronically, the claim must be identified as an ATC claim in the address section at the top of the CMS 1500 claim form (HNS/ATC is an acceptable format) using the example address below: 

Example:
HNS/ATC
PO Box 2368
Cornelius, NC 28031

 

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Claims Inquiries

 

For tracing outstanding claims (after 60 days from your billing date), please email your HNS Service Representative and include the patient name, date of birth, member ID number, and the dates of service in question. We will gladly trace the claim for you and will respond back to you within three business days.

 

Resubmit lost/missing claims through HNS.

 

Refer to the HNS/WellCare Prime by Absolute Total Care fee schedule to confirm allowable amounts.  All HNS fee schedules are located on the secure portal of the HNS website. 

 

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Provider Relations

 

Questions relating to your participation in WellCare Prime by ATC should be emailed to your HNS Service Representative. Your HNS Service Representative's email address is displayed on the provider dashboard on the secure section of the HNS website. 

 

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