The Fidelis Care Blog

Fidelis Care is committed to strengthening our partnership with providers and enhancing the overall experience when addressing claims‑related concerns. As part of this ongoing effort, we are introducing a new Fidelis Care Claims Inquiry Template, which will be required beginning March 1, 2026 for all claims inquiries submitted after the standard appeals process has been completed.

This updated process was designed to support a smoother, more transparent experience for your practice — with several key benefits:

Improved Service and Support

The new claims grid template allows us to collect all essential information at the start of your inquiry. With complete information in hand, our team can provide more accurate, focused, and effective support.

Faster, More Efficient Resolution

By standardizing and streamlining the information we receive, we can minimize unnecessary back‑and‑forth communication. This helps us resolve claims concerns more quickly and ensures your practice receives timely responses.

Better Identification of Root Causes

A consistent format enables our team to recognize trends and uncover potential system or process issues. This helps reduce the overall volume of claims‑related concerns and supports long‑term improvements that benefit your practice and our shared members.

Guidance for Global or Recurring Issues

For issues affecting multiple claims, providers only need to submit a sample of 3–5 representative claims. Please be sure to indicate that the concern is global so our team can assess broader impacts and determine whether a systemic issue exists.

Submitting Your Claims Inquiry

After receiving the outcome of your appeals, we encourage you to reach out promptly.
Once your claims grid is fully completed, please send it directly to your Provider Engagement Account Manager. This will ensure your inquiry is routed correctly and reviewed as efficiently as possible.

A link to the new Claims Inquiry Template can be found here.

We appreciate your continued collaboration and partnership as we work together to support high‑quality care for our members. If you have any questions about using the new template, please reach out — we’re here to help.

Fidelis Care is committed to strengthening our partnership with providers and enhancing the overall experience when addressing claims‑related concerns. As part of this ongoing effort, we are introducing a new Fidelis Care Claims Inquiry Template, which will be required beginning March 1, 2026 for all claims inquiries submitted after the standard appeals process has been completed.

This updated process was designed to support a smoother, more transparent experience for your practice — with several key benefits:

Improved Service and Support

The new claims grid template allows us to collect all essential information at the start of your inquiry. With complete information in hand, our team can provide more accurate, focused, and effective support.

Faster, More Efficient Resolution

By standardizing and streamlining the information we receive, we can minimize unnecessary back‑and‑forth communication. This helps us resolve claims concerns more quickly and ensures your practice receives timely responses.

Better Identification of Root Causes

A consistent format enables our team to recognize trends and uncover potential system or process issues. This helps reduce the overall volume of claims‑related concerns and supports long‑term improvements that benefit your practice and our shared members.

Guidance for Global or Recurring Issues

For issues affecting multiple claims, providers only need to submit a sample of 3–5 representative claims. Please be sure to indicate that the concern is global so our team can assess broader impacts and determine whether a systemic issue exists.

Submitting Your Claims Inquiry

After receiving the outcome of your appeals, we encourage you to reach out promptly.
Once your claims grid is fully completed, please send it directly to your Provider Engagement Account Manager. This will ensure your inquiry is routed correctly and reviewed as efficiently as possible.

A link to the new Claims Inquiry Template can be found here.

We appreciate your continued collaboration and partnership as we work together to support high‑quality care for our members. If you have any questions about using the new template, please reach out — we’re here to help.