Welcome, Providers!



8/31/2018 • 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 7/16/2018.
8/23/2018 • Posted by Provider Relations
Two new behavioral health resources are now available on our website. These new resources were developed to highlight our Behavioral Health services and enhance our efforts around care transitions.   Please utilize the Peer/Support Groups and Social Support Resource Guide to assist in the coordination of members’ services by linking them to additional resources in their community.
8/9/2018 • Posted by Provider Relations
Fidelis Care is reminding providers that Prior Authorizations can be requested online via Provider Access Online (provider portal), which is available 24/7 ~ any time of the day or night.  For greater flexibility, use the “self-service” authorization form to submit your requests online when it is convenient for you ~ with no hold or wait time! To get started:
8/1/2018 • Posted by Provider Relations
Fidelis Care will make changes to our Medicaid Managed Care, Child Health Plus, and HealthierLife formulary effective September 1, 2018 and October 1, 2018.  Some of the changes relate to quantity limitations, as well as drugs being removed and added to the formulary. To review the list and the effective dates, download formulary changes.
8/1/2018 • Posted by Provider Relations
Beginning August 13, 2018, providers submitting electronic or paper claims for non-emergent transportation services will be required to submit the pick-up and drop-off location zip codes on the claim.  Please follow the claim billing guidelines below.
Newer Articles
Older Articles

eviCore Healthcare

Access the eviCore utilization management system.

Electronic Transactions

Submit claims electronically with Fidelis Care.

Join Our Provider Network

Be part of the Fidelis Care mission. 

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. 

Learn about Fidelis Care's Quality Management Program

Provider Access Online

Verify member eligibility, check claims status, and more.

Provider Bulletin

Read the latest Provider Bulletin and browse the archives.

Manuals and Forms

Provider manuals, tip sheets, important forms, and applications.