The Fidelis Care Blog

Effective September 1, 2026, Fidelis Care will implement the Leveling of Care: Emergency Department Evaluation and Management (E/M) Overcoding for Facility Services Policy (CC.PP.80) for applicable lines of business.

Fidelis Care will host three Provider Office Hours in August 2026. During the webinars, Fidelis Care staff will be available to share information, provide an overview of provider resources, and answer your questions.

Effective August 1, 2026, Fidelis Care will implement a new pre-pay claims review process for certain claims that may involve Third-Party Liability (TPL) or Workers' Compensation coverage. This initiative is designed to help ensure claims are billed to the appropriate payer and processed accurately.

Effective August 17th, 2026, Pre- and Post-Decision Peer-to-Peer (P2P) discussions will no longer result in reconsideration of inpatient and post-acute care authorization determinations. Any reconsideration of an adverse coverage determination will instead be managed exclusively through the formal appeals process.

Fidelis Care would like to remind providers of the importance of using the appropriate submission process when requesting an expedited authorization review.