Manuals and Guides

The online Provider Manual represents the most up-to-date information on Absolute Total Care’s Medicaid Plan, programs, policies, and procedures. This manual sets forth the policies and procedures that providers participating in the Absolute Total Care network are required to follow. Contact Absolute Total Care Provider Service at 1-866-433-6041 if you have questions.

• Medicaid Provider Manual (PDF)
• Practice Guidelines

Forms

Pregnancy-Related Forms

• Shortened Notification of Pregnancy (NOP) Provider Form (PDF)
• Notification of Pregnancy (NOP) Provider Form (PDF)
• Pregnancy Incentive Reimbursement Form (PDF)

Newborn-Related Forms

• SCDHHS Form 1716 - Request for Medicaid ID Number - Infant (PDF)

Pharmacy Forms **Will open into a new window

Case Management Forms

• Member Appointment of Authorized Representative Form (PDF)
  
• Case Management Provider Referral Form (PDF)

Prior Authorization Forms

• SCDHHS Hospice Election/Enrollment Forms (PDF)
• Outpatient Prior Authorization Fax Form (PDF) - Effective 1/1/2026
• Inpatient Prior Authorization Fax Form (PDF) - Effective 1/1/2026
• Supplemental Prior Authorization Form (PDF)
• Consent for Sterilization (PDF)
• SCDHHS Certificate of Medical Necessity (CMN) for Oxygen (PDF) 
• Abortion Statement (PDF)
• Consent for Hysterectomy (PDF)
• Member Appointment of Authorized Representative Form (PDF)
  

Provider Resource Forms

• Provider Profile Sheet (PDF)

Grievance and Appeals Forms **Will open into a new window

Behavioral Health Forms **Will open into a new window

Resources

• EPSDT Program Description (PDF)
• FAQs (PDF)
• South Carolina Medicaid Bulletins
• Provider Dispute FAQs (PDF)
• Sick and Well Visit Reimbursement Letter (PDF)
• Provider Rights (PDF)
• Practitioner Credentialing Rights (PDF)
• Provider Tip Sheet (PDF)
• Claim Adjustments, Reconsiderations, and Disputes Provider Education (PDF)
• Obstetrical (OB) Incentive Programs (PDF)
• Provider Portal Enhancements: Claim Reconsideration and Denial Explanations (PDF)
• Health Literacy and Culture (PDF)

Provider Town Hall Meetings

• Provider Town Hall Q1 2025 (PDF)
• Provider Town Hall Q2 2025 (PDF)
• Provider Town Hall Q3 2025 (PDF)
• Provider Town Hall Q4 2025 (PDF)

New Provider Orientation

• New Provider Orientation (PDF)

Manuals and Guides

• Medicare-Medicaid Provider Manual (PDF)
• Practice Guidelines

The online Provider Manual represents the most up-to-date information on Wellcare Prime by Absolute Total Care (Medicare-Medicaid Plan), programs, policies, and procedures. This manual sets forth the policies and procedures that providers participating in the Wellcare Prime network are required to follow. Contact Wellcare Prime Provider Service at 1-855-735-4398 if you have questions.

Forms

• Provider Dispute Form (PDF)
• Waiver of Liability Statement (PDF)
• Provider Profile Sheet (PDF)
• Authorization to Use and/or Disclose Health Information (PDF)
• Revocation of Authorization to Use and/or Disclose Health Information (PDF)
• Claim Adjustment/Resubmission Form (PDF)

Resources

• Balance Billing Quick Reference Guide (PDF)
• Jimmo v. Sebelius Summary of Questions and Responses (PDF)
• Jimmo v. Sebelius Settlement Agreement (PDF)
• Provider Dispute FAQ (PDF)
• New Provider Orientation (PDF)

Manuals and Forms for Providers

Provider Manual

• Provider Manual (PDF)

Prior Authorization Forms

• Inpatient Prior Authorization Form (PDF)
• Outpatient Prior Authorization Form (PDF)

Pharmacy Services

• Pharmacy Services Resources and Forms
• Formulary Search Tool

Quality Improvement

• 2026 Annual Preventive Visit Flyer (PDF)

Vendors

• Liberty Dental 
• Envolve Vision

Resources

• Aligned D-SNP FAQs and Information (PDF)
• Guide to Reading a Member ID Card (PDF)
• Key Plan Information for Wellcare By Absolute Total Care (PDF)
• PCP Change Request Form (PDF)
• Provider Waiver of Liability (WOL) Form (PDF)
• Managing Duals Digitally FAQs (PDF)