Filing Advicare Advocate Claims

PROVIDER ALERT

On June 1, 2016, Advicare Corp., a managed care organization in South Carolina, was purchased by WellCare Health Plans, Inc. As a result of this purchase Advicare Advocate, Advicare's Medicare-Medicaid Plan (MMP), will no longer participate in the Healthy Connections Prime program. Effective Sept. 1, 2016, existing Advicare Advocate members will have new health insurance, either with another MMP or traditional Medicare and Healthy Connections Medicaid.

Advicare Advocate will continue to process provider claims for dates of service before Sept. 1, 2016, as long as they meet the timely filing requirement of 365 days. Claims can be sent to: Advicare, P.O. Box 5547, Hauppauge, NY 11788.

All members will continue to receive their health care services, including prescription drugs, either through another MMP or under traditional Medicare and Healthy Connections Medicaid. There will be no gap in coverage for Medicaid, Medicare or Medicare Part D prescription drugs.

If a member is transferred to another MMP, he/she will be able to continue to see his/her current doctors and other providers for a six month "continuity of care" period. The new MMP will honor all prior authorizations for upcoming medical procedures and make sure members have access to their current prescriptions for six months.

For members receiving waiver services, participants will maintain their provider and service authorization levels for waiver services during the continuity of care period, unless there is a change in the service needs. Depending on the member's options, the new MMP care coordinator or the state case manager will work with the waiver case manager to help transition the member.

For services rendered on or after Sept. 1, 2016, please call the telephone number on the patient's new member identification card.

For a list of frequently asked questions, visit the Advicare Advocate transition on the Healthy Connections Prime website: https://msp.scdhhs.gov/SCDue2/press-release/advicare-advocate-transition. If you have additional questions, please call the Advicare provider line at (844) 564-0143.

Thank you for your continued support of the South Carolina Healthy Connections Medicaid program.

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