Fidelis Care Artificial Intelligence (AI) Tool Usage Disclosure

Fidelis Care may use artificial intelligence (AI) tools to help improve the efficiency, accuracy, and quality of services provided to our members and business partners. These tools are used under established privacy, security, and governance controls.

Fidelis Care is committed to using AI tools in a manner that is ethical, transparent, and secure.

• We provide information about our use of AI tools so members understand how technology may support our services and decision-making processes.
• We have policies and processes in place to test and monitor AI systems for potential bias and unlawful discrimination.
• Our AI Governance program is designed to support compliance with applicable laws, regulations, and organizational requirements governing the use of AI.

Below are examples of how Fidelis Care may use AI systems.

• Some AI tools support document reviews, organize information, and improve business process workflows.
• AI tools may help identify when certain information is missing from a prior-authorization submission.
• AI tools may also help organize or summarize information more quickly for clinical reviewers.
• AI tools may assist in the review of certain prior authorization requests and help identify requests that appear eligible for approval, allowing members to receive approval decisions more quickly. Fidelis Care does not use AI tools to independently deny, delay, reduce, or modify service requests. All AI-supported outputs are subject to review by qualified medical professionals.

Fidelis Care may share members protected health information (PHI) with contracted vendors that use AI tools to support the services we provide. We require contracted vendors that use AI tools on our behalf to implement appropriate privacy, security, and governance safeguards. We also periodically assess their use of AI tools to help ensure these safeguards remain effective.

Members with questions about how Fidelis Care uses AI tools can contact the Member Services department at 1-888-343-3547 (TTY: 711).