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9/12/2019 • Posted by Provider Relations
Fidelis Care’s contract with clearinghouse Post-n-Track (PNT data) has expired. Providers who currently use Post-n-Track to submit 837 claims will need to submit claims through another clearinghouse. Fidelis Care network providers, who submit 837 claims, can now submit claims to Fidelis Care through clearinghouse Availity - for free!
9/10/2019 • Posted by Provider Relations
As a reminder, Prior Authorizations can be requested online via Provider Access Online (provider portal), which is available 24 hours a day, 7 days a week. Use the “self-service” authorization form to submit your requests online when it is convenient for you ~ with no hold or wait time!
9/9/2019 • Posted by Provider Relations
Fidelis Care has engaged National Imaging Associates, Inc. (NIA) to implement a new authorization program to manage outpatient rehabilitative and habilitative physical medicine services, including services rendered in the home, for services rendered on or after October 1, 2019.
9/6/2019 • Posted by Provider Relations
The delegation of Prior Authorization to TurningPoint Healthcare Solutions, LLC has been delayed until further notice and is pending New York State approval. In the interim, for services on or after October 1, 2019, Prior Authorization will be required for orthopedic surgical procedures and spinal surgical procedures, for both inpatient and outpatient settings, through Fidelis Care’s Authorization Department via Provider Access Online (provider portal), Fax: (800) 860-8720 , or Phone: (888) 343-3547.
8/30/2019 • Posted by Provider Relations
The following sections of the Fidelis Care authorization grids have been updated effective October 1, 2019. The following services require prior authorization based on the health insurance product as outlined below:
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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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