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LATEST NEWS


Friday • Posted by Provider Relations
Claims received by Fidelis Care that contain invalid or missing information cannot be processed. The unprocessed claim(s) is updated in our Claims Processing System with a status of “Closed” and the claim(s) is returned to the provider along with a letter explaining the reason for the rejection. Provider Access Online (provider portal) has been updated to allow portal users the ability to view a copy of the original letter.
7/3/2019 • Posted by Provider Relations
As your health plan partner, Fidelis Care would like to inform you of the following updates to help ensure accuracy in claims submissions. For COB Submissions Received without Claims Attached:
7/1/2019 • Posted by Provider Relations
The following sections of the Fidelis Care authorization grids have been updated effective August 1, 2019. The following service applies to all lines of business and requires prior authorization:
7/1/2019 • Posted by Provider Relations
Fidelis Care is pleased to inform you that the most recent 2019 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 05/20/2019.
6/20/2019 • Posted by Provider Relations
Fidelis Care encourages providers to participate and/or continue in behavioral health claims testing opportunities. Network providers who are participating in New York State’s Children and Family Treatment and Support Services and/or Children’s Home and Community Based Services program for children and youth enrolled in Medicaid Managed Care with health and behavioral health needs are encouraged to submit a request for claims testing.
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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. 

Fidelis Care is committed to ensuring that members have the care and services they need. 

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