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LATEST NEWS


3/22/2019 • Posted by Provider Relations
This communication is to inform you that a change in the format of Fidelis Care's 835 (ERA) will take place on 3/28/2019. This update is informational only and will not affect receipt of your 835 files. ERAs delivered by Fidelis Care will no longer have the Bank Routing information in the BOP segment BPR09.
3/21/2019 • Posted by Provider Relations
The following section of the Fidelis Care authorization grids has been updated effective May 1, 2019.
3/15/2019 • Posted by Provider Relations
It is vital to educate our members on the importance of monitoring and controlling high blood pressure to prevent the increased risk of stroke and heart disease.
3/12/2019 • Posted by Provider Relations
Like all other health plans, Fidelis Care is required by the State Department of Health (SDOH) to submit complete diagnostic data for members enrolled in New York State Medicaid Managed Care health plans. In order to meet this requirement, we request medical records to ensure all diagnostic data is reported completely and accurately.
3/8/2019 • 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!
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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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