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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.
7/31/2018 • Posted by Provider Relations
As previously communicated, Fidelis Care is no longer accepting corrected claims that are incorrectly billed. Providers submitting paper corrected claims to Fidelis Care must follow the Important Guidelines for Corrected Claims, which are available below.
7/31/2018 • Posted by Provider Relations
Fidelis Care is pleased to announce that we have 3 new inpatient prior authorization fax forms available on this site. Be sure to fill out the forms completely with all relevant information to help us expedite the processing of your requests.
7/31/2018 • 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 6/18/2018.
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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. 

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

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