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Fidelis Care has updated the required Provider Appeals Form for providers to use for submitting Administrative Reviews and Provider Appeal requests. The Provider Appeals Form must be used if a claim has been processed and a remittance advice has been issued from Fidelis Care and the provider is requesting a review. Do not use for first time claims or corrected claims. All claim requests for reconsideration, corrected claims, or claim disputes must be received within 60 calendar days from the date of the remittance. Before submitting this required form, please be sure the form is completed in its entirety so that your request can be processed immediately. Currently, the form should be mailed as follows:
Correspondence Type:
Product:
Mail to Current Address:
Claim Administrative Reconsiderations
Claim Appeals
Medicaid Managed Care Child Health Plus Fidelis Care at Home (MLTC) HealthierLife (HARP)
Claims Department Fidelis Care 480 CrossPoint Pkwy. Getzville, NY 14068
MarketPlace: Qualified Health Plan Exchange Off Exchange Essential Plans
Medicare Advantage Medicare Dual Advantage
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