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Finding Helpful Information about Fidelis Care
5/15/2019 • Posted by Provider Relations

Providers, please remember to review content available in Provider Access Online (Fidelis Care’s secure Provider Portal) and the rest of this Provider section of the Fidelis Care website.  Both locations are excellent resources of information about our programs and services.  One example of a resource contained in this site is our Provider Manual.  The Provider Manual contains details about our credentialing processes and our member rights and responsibilities statement.  It also includes information about the clinical criteria used in utilization management (UM) decision-making, our pharmacy authorization processes, and Fidelis Care’s policy statement on how coverage decisions are made.

Other items you will find in the Provider section of the Fidelis Care website include information about referring members for case and disease management services.  If you have further questions regarding any of the content on the website, please contact us at 1-888-FIDELIS (1-888-343-3547).
 

eviCore Healthcare

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Electronic Transactions

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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. 

Learn about Fidelis Care's Quality Management Program


Provider Access Online

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Provider Bulletin

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Manuals and Forms

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