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11/30/2019 • Posted by Provider Relations
The following sections of the Fidelis Care authorization grids have been updated effective January 1, 2020.
11/27/2019 • 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 10/21/2019.
11/21/2019 • Posted by Provider Relations
Fidelis Care wants our members to lead healthy lives in their communities. A new performance improvement project (PIP) has been created for our HealthierLife (Health and Recovery Plan – HARP) members who experience frequent hospital admissions and emergency room visits for a behavioral health issue. The goal of this PIP is to prevent readmissions.
11/18/2019 • Posted by Provider Relations
In January 2019, Fidelis Care initiated the Medicaid KIDS Performance Improvement Project (PIP): Optimizing Children’s Health and Development to Improve Long-Term Outcomes. The aim of this PIP is to improve children’s health by increasing lead, hearing, and developmental screenings with appropriate follow-up by the time the child reaches 3 years of age. The project will run through December 2020.
11/4/2019 • Posted by Provider Relations
Currently, there are no authorization changes planned for November 2019.
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Each day, Fidelis Care's Utilization Management (UM) Department makes decisions on many health insurance claims. These decisions are based only on appropriateness of care and the existence of coverage. 

Fidelis Care does not reward providers or other individuals for issuing denials of coverage, and does not offer financial incentives to UM staff based on decisions that promote underutilization of services. 

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