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
Fidelis Care accepts HIPAA-compliant healthcare claims (x12 5010 837I & 837P) originating from multiple sources. The most efficient and preferred method is through your clearinghouse. Please verify that your clearinghouse will forward your submitted claims to Fidelis Care.  

If you are currently submitting more than 200 claims per month to Fidelis Care, please contact the Provider Call Center at 1-888-FIDELIS (1-888-343-3547) to learn more about direct claims submission options. 

If you have further questions about submitting claims electronically, please contact the Provider Call Center at 1-888-FIDELIS (1-888-343-3547).

Claims Submission Routes
Fidelis Care claims can be submitted in several different ways. Below is a list of claim submission options to consider:
  • Clearinghouse Submission
  • Billing Service Submission
  • Direct Submission (200 claims per month minimum)
  • Co-Branded Portal (professional claims only accepted)
  • Claims Online Portal (professional and institutional claims accepted)
  • Paper Submission


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 REF01Element equals F8, REF02 Element must contain Fidelis Original Claim Number.
Electronic Remittance Advices
Electronic Remittance Advices
If you would like to receive the HIPAA-mandated 835 (x12 5010) Electronic Remittance Advice and/or submit 837 (x12 5010) claims directly to Fidelis Care, please complete the eCommerce Request form.
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.