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LATEST NEWS


12/28/2018 • Posted by Provider Relations
Fidelis Care is pleased to announce a new pilot program for our participating primary care and specialty providers who are delivering care to members of the Essential Plan (EP) and HealthierLife, Fidelis’ Health and Recovery Plan (HARP) for adults with behavioral health conditions most in need.
12/28/2018 • 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 11/12/2018.
12/20/2018 • Posted by Provider Relations
Fidelis Care is pleased to announce the new Quality Care Incentives (QCI) Brochure is now available on Provider Access Online.
12/18/2018 • Posted by Provider Relations
Fidelis Care is working to support the HEDIS Measure for Use of Imaging Studies for Low Back Pain (LBP).  As defined by HEDIS, use of imaging studies for low back pain includes the percentage of members 18-50 years of age who had a primary diagnosis of low back pain and did not have an imaging study (plain X-ray, MRI, CT scan) within 28 days of diagnosis. 
12/10/2018 • Posted by Provider Relations
Annually, Fidelis Care is required by the Centers for Medicare and Medicaid Services (CMS) to submit complete diagnostic data for Qualified Health Plan members. To help us obtain the necessary medical records for submission, Fidelis Care is working in partnership with Optum and CiOX Health*.
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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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