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LATEST NEWS


Wednesday • Posted by Provider Relations
Annually, Fidelis Care is required by the Centers for Medicare and Medicaid Services (CMS) to submit complete diagnostic data for Medicare members. To help us obtain the necessary medical records for submission, Fidelis Care is working in partnership with Optum and CiOX Health*. If you have received a packet requesting medical records, please be aware that records must be received no later than December 14, 2018.
Last Week • Posted by Provider Relations
Fidelis Care provides voluntary Population Health Management (PHM) programs that meet the care needs of its entire member population, across the continuum of care. The PHM programs focus on the “whole person” and the member’s entire care journey.
9/6/2018 • Posted by Provider Relations
As you know, prior authorizations can be requested online via Provider Access Online (Fidelis Care’s secure provider portal). Did you know you can also check the status of authorizations using the provider portal? With this option, you no longer have to call in to check the status.
9/5/2018 • Posted by Provider Relations
Beginning in September 2018, there will be an authorization requirement change for Fidelis Care at Home (FCAH) members who are also covered by a Medicare plan, which is the member’s primary coverage plan. Read more...
8/31/2018 • Posted by Provider Relations
Fidelis Care is pleased to inform you that the most recent 2018 QARR Non-Compliance Report has been posted on Provider Access Online (provider portal). This information is indicative of all encounter data on file with Fidelis Care as of 7/16/2018.
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Important Information on Coverage Decisions

Each day, Fidelis Care's Utilization Management (UM) Department makes decisions on numerous health insurance claims. These decisions are based only on appropriateness of care and the existence of coverage. 

Fidelis Care does not reward practitioners or other individuals for issuing denials of coverage, and does not offer financial incentives to UM staff that would encourage decisions that result in underutilization of services. 

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