Electronic Transactions

Submitting claims electronically means:
  • Faster processing and reimbursement of clean claims
  • Reduction and/or elimination of the number of claims being rejected
  • Proof of timely submission through electronic acceptance reports
  • Sending and receiving claims documents electronically
Electronic Submission of Claims

Submitting claims electronically leads to quicker payment of claims and saves costs in mailing. It also makes it easier for providers to receive a claim receipt and claim status report.

Fidelis Care’s preferred clearinghouse for electronic claims submission is Availity. To enroll, please call Availity Client Services at 1-800-AVAILITY (1-800-282-4548).

Claims can also be submitted through clearinghouse Ability, or another clearinghouse. Fidelis Care offers free online claims submission through Ability’s claims portal. To learn more about Ability, call 1-888-499-5465 or visit mdol.com/fideliscare. You also have the option to contact another clearinghouse to initiate 837-claim submission to Fidelis Care.Please confirm with the clearinghouse that they will forward claims to Fidelis Care on your behalf.

Electronic Submission of Corrected Claims

To submit corrected claims electronically:

  • The original claim number must be submitted 
  • The claim frequency type code must be a 7 (replacement of prior claim)
  • 2300 Loop, CLM Claim Information Segment, CLM05-3 Claim Frequency Type Code Element must be set to a 7 and 2300 Loop
  • REF Original Reference Number (ICN/DCN) Segment where REF01 Element equals F8, REF02 Element must contain Fidelis Care Original Claim Number
  • Only one correction for a Fidelis Care Original Claim Number should be submitted per day
Electronic Remittance Advices
To  receive 835 Electronic Remittance Advices for Fidelis Care claims, please  contact your clearinghouse.
Electronic Funds Transfer
If you would like to receive Electronic Funds Transfer, please complete the EFT Enrollment.

Provider Access Online

Verify member eligibility, check claims status, and more.

Lost or Missing Transactions

Options for connecting a payment to the appropriate remittance advice.