Welcome, Providers!



7/19/2019 • Posted by Provider Relations
Fidelis Care is pleased to announce that a new Provider Bulletin is now available. The bulletin features updates on important initiatives and the latest news of interest to our provider community. Articles included are:
7/12/2019 • Posted by Provider Relations
Claims received by Fidelis Care that contain invalid or missing information cannot be processed. The unprocessed claim(s) is updated in our Claims Processing System with a status of “Closed” and the claim(s) is returned to the provider along with a letter explaining the reason for the rejection. Provider Access Online (provider portal) has been updated to allow portal users the ability to view a copy of the original letter.
7/3/2019 • Posted by Provider Relations
As your health plan partner, Fidelis Care would like to inform you of the following updates to help ensure accuracy in claims submissions. For COB Submissions Received without Claims Attached:
7/1/2019 • Posted by Provider Relations
The following sections of the Fidelis Care authorization grids have been updated effective August 1, 2019. The following service applies to all lines of business and requires prior authorization:
7/1/2019 • 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 05/20/2019.
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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. 

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