A. In this section, we will explain how you can tell us about these concerns/grievances. P.O. WellCare Medicare members are not affected by this change. PROVIDERS NOTE:Please send Corrected Claims as normal submissions via electronic or paper. Register now at https://www.payspanhealth.comor contact PaySpan at providersupport@payspanhealth.com, or 877-331-7154. It can also be about a provider and/or a service. Division of Appeals and Hearings Overview & Resources WellCare of North Carolina partners with providers to develop and deliver high-quality, cost-effective health care solutions. Contact Wellcare Prime Provider Service at 1-855-735-4398 if you have questions. To do so by phone, call Member Services at 1-888-588-9842 (TTY1-877-247-6272). You or your provider must call or fax us to ask for a fast appeal. pst/!+ Y^Ynwb7tw,eI^ 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. 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. P.O. We encourage you to check the Medicaid Pre-Auth Check Toolto ensure that you are accessing the most current Absolute Total Care authorization requirements for dates of service on or after April 1, 2021. It will tell you we received your grievance. State Health Plan State Claims P.O. As of April 1, 2021, WellCare will no longer be a separate plan option offered by South Carolina Healthy Connections Choices. They are called: State law allows you to make a grievance if you have any problems with us. hbbd``b`$= $ A. We want to ensure that claims are handled as efficiently as possible. 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. * Password. We process check runs daily, with the exception of Sundays, National Holidays, and the last day of the month. Box 100605 Columbia, SC 29260. 0 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. 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. Absolute Total Care will honor all existing WellCare authorization approvals that include dates of service beyond March 31, 2021. All dates of service on or after 4/1/2021 should be filed to Absolute Total Care. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. Our fax number is 1-866-201-0657. Welcome to WellCare of South Carolina! We must have your written permission before someone can file a grievance for you. #~0 I WellCare claims will be processed according to timely filing provisions in the providers WellCare Participating Provider Agreement. A. Wellcare uses cookies. For the latest COVID-19 news, visit the CDC. Coronavirus Disease 2019 (COVID-19) causes respiratory illness in people and can spread from person to person. We will call you with our decision if we decide you need a fast appeal. If you file a grievance or an appeal, we must be fair. 941w*)bF iLK\c;nF mhk} With the completion of this transaction, we have created a premier healthcare enterprise focused on government-sponsored healthcare programs. z4M0(th`1Lf`M18c BIcJ[%4l JU2 _ s We will notify you orally and in writing. 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. Your second-level review will be performed by person(s) not involved in the first review. 1044 0 obj <> endobj The Medicare portion of the agreement will continue to function in its entirety as applicable. 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. We try to make filing claims with us as easy as possible. Members will need to talk to their provider right away if they want to keep seeing him/her. You can get many of your Coronavirus-related questions answered here. Q. Box 3050 How do I determine if an institutional inpatient bill type submission overlapping 4/1/2021 should be filed to WellCare or Absolute Total Care? Wellcare uses cookies. 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. Call us to get this form. 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. Obstetrician care provided by an out of network Obstetrician will be covered for pregnant members inclusive of post-partum care. Wellcare wants to ensure that claims are handled as efficiently as possible. We would like to help your billing department get your EDI (claims and real time) transactions processed as efficiently as possible. A hearing officer from the State will decide if we made the right decision. Will Absolute Total Care continue to offer Medicare and Marketplace products? You can file the grievance yourself. The way your providers or others act or treat you. 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. Learn how you can help keep yourself and others healthy. Hearings are used when you were denied a service or only part of the service was approved. Explains how to receive, load and send 834 EDI files for member information. 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. Please be sure to use the correct line of business prior authorization form for prior authorization requests. Tampa, FL 33631-3384. Please Explore the Site and Get To Know Us. Members who are dealing with stress or anxiety can call our 24-Hour Behavioral Health Crisis Line at 1-833-207-4240 to speak with a trained professional. 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. Contact Absolute Total Care Provider Service at1-866-433-6041if youhave questions. We will also send you a letter with our decision within 72 hours from receiving your appeal. Claims Submission, Correspondence and Contact Resources will stay the same for the Medicare line of business. P.O. With quality healthcare solutions, Ambetter from Absolute Total Care helps residents of South Carolina live better. WellCare Medicare Advantage Claims must be filed within 180 calendar days from the date of service. Members who are dealing with stress or anxiety can call our 24-Hour Behavioral Health Crisis Line at 1-833-207-4240 to speak with a trained professional. Send your written appeal to: We must have your written consent before someone can file an appeal for you. A. Resources Download the free version of Adobe Reader. You and the person you choose to represent you must sign the AOR statement. At the hearing, well explain why we made our decision. We expect this process to be seamless for our valued members and there will be no break in their coverage. Q. We may apply a 14 day extension to your grievance resolution. Earliest From Dates on or after 4/1/2021 should be filed to Absolute Total Care. Explains rules and state, line of business and CMS-specific regulations regarding 837P EDI transactions. 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. 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 4/1/2021 if the provider is in network with both WellCare and Absolute Total Care. Box 8206 WellCare offers participating providers EFT and ERA services at no charge through PaySpan Health. From Date Institutional Statement Dates prior to 4/1/2021 should be filed to WellCare of South Carolina. A provider can act for a member in hearings with the member's written permission in advance. 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. Members must have Medicaid to enroll. A. We are proud to announce that WellCare is now part of the Centene Family. The provider needs to contact Absolute Total Care to arrange continuing care. P.O. Copyright 2023 Wellcare Health Plans, Inc. Members will receive a 90-day transition of care period if the member is receiving ongoing care and treatment. A. This manual sets forth the policies and procedures that providers participating in the Wellcare Prime network are required to follow. %%EOF Payments mailed to providers are subject to USPS mailing timeframes. Forgot Your Password? Welcome to Wellcare By Allwell, a Medicare Advantage plan. Q. Download the free version of Adobe Reader. Absolute Total Care will continue to offer Marketplace products under the Ambetter brand. Providers can help facilitate timely claim payment by having an understanding of our processes and requirements. %PDF-1.6 % 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. We have licensed clinicians available to speak with you and to connect you to the support you need to feel better. A. Awagandakami Professional and Institutional Fee-For-Service EDI transactions should be submitted to WellCare of South Carolina Medicaid with Payer ID 14163. It will let you know we received your appeal. Please contact our Provider Services Call Center at 1-888-898-7969. Date of Occurrence/DOSApril 1, 2021 and after: Processed by Absolute Total Care. 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. You must ask within 30 calendar days of getting our decision. BlueCross BlueShield of South Carolina Piedmont Service Center P.O. Members will receive a 90-day transition of care period if the member is receiving ongoing care and treatment. 2) Reconsideration or Claim disputes/Appeals. However, as of April 1, 2021, all WellCare of South Carolina Medicaid members will become Absolute Total Care members. 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. 2023 Medicare and PDP Compare Plans and Enroll Now. We expect this process to be seamless for our valued members, and there will be no break in their coverage. Thanka kaa yoa Tufrbeau ingsnh ngetfu South Caralaita nouMa mpvd. Providers interested in joining the Absolute Total Care vision network for routine vision services can contact Envolve Vision at 1-800-531-2818. 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 Q. Kasapulam ti tulong? 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. WellCare of South Carolina will be known as Absolute Total Care as of April 1, 2021. You and the person you choose to represent you must sign the AOR 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. Claim Filing Manual - First Choice by Select Health of South Carolina Explains rules and state, line of business and CMS-specific regulations regarding 837I EDI transactions. 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. you have another option. WellCare claims will be processed according to timely filing provisions in the providers WellCare Participating Provider Agreement. 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. Exceptions to the one-year time limit: a) Medicare Cost Sharing Claims . However, there will be no members accessing/assigned to the Medicaid portion of the agreement. This manual sets forth the policies and procedures that providers participating in the Absolute Total Carenetwork are required tofollow. 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. 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. You, your friend, a relative, legal counsel or other spokesperson who has your written consent may ask for a State Fair Hearing. You can also have a video visit with a doctor using your phone or computer. At WellCare, we value everything you do to deliver quality care to our members your patients and ensure they have a positive health care experience. April 1-April 3, 2021, please send to Absolute Total Care. Claims Department A. How are WellCare Medicaid member authorizations being handled after April 1, 2021? All Paper Claim Submissions can be mailed to: WellCare Health Plans An appeal is a request you can make when you do not agree with a decision we made about your care. 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. Select Health Claims must be filed within 12 months from the date of service. There is a lot of insurance that follows different time frames for claim submission. 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 can ask for a State Fair Hearing after we make our appeal decision. Q. Claims for services on or after April 1, 2021 should be filed to Absolute Total Care for processing. If Statement Range is April 2, 2021 through April 10, 2021, please send to Absolute Total Care. 8h} \x p`03 1z`@+`~70 G ~Ws5Puick79,4 ,O5@?O-Gr'|5Oj:v6/` Q. and Human Services 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. Please use the Earliest From Date. The annual flu vaccine helps prevent the flu.Protect yourself and those around you. WellCare offers participating providers EFT and ERA services at no charge through PaySpan Health. To avoid rejections please split the services into two separate claim submissions. 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. Symptoms are flu-like, including: Fever Coughing With the completion of this transaction, we have created a premier healthcare enterprise focused on government-sponsored healthcare programs. 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. Within five business days of getting your grievance, we will mail you a letter. Pregnant members receiving care from an out-of-network Obstetrician can continue to see their current obstetrician until after the baby is born. Outpatient Prior Authorization Form (PDF) Inpatient Prior Authorization Form (PDF) Effective January 1, 2015 the South Carolina Department of Health and Human Services (SCDHHS) will implement a Claim Reconsideration Policy. Claims for services prior to April 1, 2021 should be filed to WellCare for processing. 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. Q. Reimbursement Policies This includes providing assistance with accessing interpreter services and hearing impaired . We will review it and send you a decision letter within 30 calendar days from receiving your appeal. It is called a "Notice of Adverse Benefit Determination" or "NABD." Those who attend the hearing include: You can also request to have your hearing over the phone. Q. Need an account? P.O. 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. Contact Us Y0020_WCM_100876E Last Updated On: 10/1/2022 WellCare claims will be processed according to timely filing provisions in the providers WellCare Participating Provider Agreement. WellCare Medicare members are not affected by this change. 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. Timely filing is when you file a claim within a payer-determined time limit. You will receive an acknowledgement letter within 5 business days, and we will send you a resolution within 90 calendar days. Section 1: General Information. Earliest From Dates prior to April 1, 2021 should be filed to WellCare of South Carolina. Q. 1,flQ*!WLOmsmz\D;I5BI,yA#z!vYQi5'fedREF40 b666q1(UtUJJ.i` (T/@E Shop or Enroll in a Plan Frequently Asked Questions Find a Doctor Download Digital ID Card Welcome Allwell Members! A. 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). You can file your appeal by calling or writing to us. WellCare Health Plans, Inc. (NYSE: WCG) is now offering a $120 credit per family, per year towards over-the-counter (OTC) items as part of its Medicaid program benefits in South Carolina. DOS prior toApril 1, 2021: Processed by WellCare. Tampa, FL 33631-3372. We are glad you joined our family! In South Carolina, WellCare and Absolute Total Care are joining to better serve you. Wellcare uses cookies. If you request a hearing, the request must: A State Fair Hearing is a legal proceeding. The Claim Reconsideration process is an informal claim review, and is not a substitute for an appeal of a final agency decision. hYnH~}9'I`@>cLq,&DYH"W~&eJx'"luWU]JDBFRJ!*SN(s'6# ^*dg4$SB7K4z:r6')baka+Raf4J=)l, _/jaSpao69&&_Ln=?/{:,'z .1J0|~jv4[eUN{:-gl! K'&hng?y},&X/|OzcJ@0PhDiO})9RA9tG%=|rBhHBz7 837 Institutional Encounter 5010v Guide Here are some guides we created to help you with claims filing. Providers will continue to follow WellCares Medicaid policies and procedures for services provided to WellCare Medicaid members for dates of service prior to April 1, 2021. Professional and Institutional Encounter EDI transactions should be submitted to WellCare of South Carolina Medicaid with Payer ID 59354. We understand that maintaining a healthy community starts with providing care to those who need it most. 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. Our toll-free fax number is 1-877-297-3112. Will my existing WellCare patients be assigned to my Absolute Total Care Panel? Ambetter from Absolute Total Care - South Carolina. Provider can't require members to appoint them as a condition of getting services. This person has all beneficiary rights and responsibilities during the appeal process. 1096 0 obj <>stream By continuing to use our site, you agree to our Privacy Policy and Terms of Use. The timely filing limit is the time duration from service rendered to patients and submitting claims to the insurance companies. To do this: You will get a letter from us when any of these actions occur. Ambetter Timely Filing Limit of : 1) Initial Claims. Claims will be processed according to timely filing provisions in the providers Absolute Total Care Participating Provider Agreement. 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 4/1/2021 will transfer with the members eligibility to Absolute Total Care. Check out the Interoperability Page to learn more. As of April 1, 2021, all WellCare of South Carolina Medicaid members will become Absolute Total Care members. Copyright 2023 Wellcare Health Plans, Inc. They must inform their vendor of AmeriHealth Caritas . WellCare has partnered with Change Healthcare as our preferred EDI Clearinghouse. For dates of service on or after April 1, 2021: Absolute Total Care Or it can be made if we take too long to make a care decision. If Statement Range is March 14, 2021 through April 3, 2021, please send to WellCare. Incorrect forms will not be considered and may lead to further delays in processing prior authorization requests. You can get many of your Coronavirus-related questions answered here. Wellcare uses cookies. 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. 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. What will happen to my Participating Provider Agreement with WellCare after 4/1/2021? WellCare of South Carolinawants to ensure that claims are handled as efficiently as possible. 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. 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. Providers can help facilitate timely claim payment by having an understanding of our processes and requirements. Will Absolute Total Care change its name to WellCare? To do this: Be sure to ask us to continue your benefits within the 10 calendar day time frame. South Carolina DEPARTMENT OF HEALTH AND HUMAN SERVICES Post Office Box 8206 Columbia, South Carolina 29202-8206 www.scdhhs.gov November 24, 2009 ALL . 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. WellCare of South Carolina will be known as Absolute Total Care as of April 1, 2021. Members will need to talk to their provider right away if they want to keep seeing him/her. Earliest From Dates on or after April 1, 2021 should be filed to Absolute Total Care. For additional information, questions or concerns, please contact your local Provider Network Management Representative. Here you will find the tools and resources you need to help manage your submission of claims and receipt of payments. 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. 3) Coordination of Benefits. 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. How do I bill a professional submission with services spanning before and after 04/01/2021? Q. Explains rules and state, line of business and CMS-specific regulations regarding 837I EDI transactions. 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