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LATEST NEWS


Monday • Posted by Provider Relations
Annually, Fidelis Care is required by the Centers for Medicare and Medicaid Services (CMS) to submit complete diagnostic data for Qualified Health Plan members. To help us obtain the necessary medical records for submission, Fidelis Care is working in partnership with Optum and CiOX Health*.
Last Week • Posted by Provider Relations
On January 1, 2019, the Medicare Preferred Drugs list will change. To ease the transition, impacted members and providers have been notified of the upcoming changes.
Last Week • Posted by Provider Relations
As a Medicare/Medicare-Medicaid provider, you know that quality health care is a high priority for Fidelis Care and the Centers for Medicare & Medicaid Services (CMS). CMS considers statin use an important quality measure in patients with diabetes.
11/30/2018 • 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 10/15/2018.
11/29/2018 • Posted by Provider Relations
The following sections of the Fidelis Care authorization grids have been updated effective January 1, 2019. The following services apply to all product lines of business and require prior authorization:
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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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