Welcome, Providers!



Friday • Posted by Provider Relations
Coronavirus disease 2019 is a new and emerging illness in the United States. The virus causes a disease called COVID-19 that can lead to fever, cough and shortness of breath. There are thousands of confirmed cases in a growing number of countries internationally, and the virus is now spreading in the United States, including New York State. New information, obtained daily, further informs the risk assessment, treatment options, and next steps.
Friday • Posted by Provider Relations
Providers, please remember to review content available in Provider Access Online (Fidelis Care's secure Provider Portal) and the rest of this Provider section of the Fidelis Care website. Both locations are excellent resources of information about our programs and services. One example of a resource contained in this site is our Provider Manual.
Wednesday • Posted by Provider Relations
Effective 5/1/2020, Fidelis Care is implementing three new post office (P.O.) boxes for certain provider claims correspondence*.  These new P.O. boxes, along with additional processes, will help to improve our receipt and inventory tracking of certain provider correspondence mail for claims processing efficiencies. Please mail the specific correspondence types below to the new P.O. Boxes according to the member’s product as indicated: Correspondence  Type* Product Mailing Address Effective through 4/30/2020
Wednesday • Posted by Provider Portal
Fidelis Care is pleased to inform you that the medical record second request letter and details for 2020 HEDIS/QARR have been posted on our Provider Portal, Provider Access Online (PAO). Please review these materials and send the requested documentation to Fidelis Care as soon as possible.
Tuesday • Posted by Provider Relations
Fidelis Care has expanded its behavioral health care management program. This expansion included additional outreach and care coordination with behavioral health providers serving Fidelis Care members with higher needs for services and care coordination. Members were identified based on high utilization and/or a combination of low utilization of outpatient behavioral health services following an acute behavioral health inpatient or emergency department episode.
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Important Information on Coverage Decisions

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. 

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

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