Welcome, Providers!

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. 

To view a copy of the original letter for a returned/rejected claim (Status - Closed), follow the steps below:

Step 1.  Login to Provider Access Online (provider portal).

Step 2.  On the Home Page, select ‘Claims’ in the vertical menu list. 

Step 3.  Key in the 9-digit ‘Subscriber ID’ number and the claim date of service range in the 
               ‘From’ and ‘To’ date fields.  Click the ‘Search’ button.

          Note:  Claims that meet the criteria will be displayed in the ‘Claims’ window as shown in the screen
                       shot example below.

Claims screen shot example:

Step 4:  To view a claim letter for a returned/rejected claim (status = Closed), for a line that indicates “Returned”
                in the ‘Status’ column, click the ‘Returned’ hyperlink. 

          Notes:
           • Refer to the returned/rejected Claim Letter example as shown in the screen shot below.
           • If a claim letter is too old to view, the ‘Status’ field indicating “Returned” will not contain a hyperlink and;
              therefore, cannot be viewed.
           • If you have questions on an older returned claim, and the letter cannot be viewed, please contact the
              Provider Call Center at 1-888-FIDELIS (1-888-343-3547).

Returned/rejected claim letter example:

Important Note!  A returned/rejected claim for invalid or missing information should be corrected and resubmitted to Fidelis Care as soon as possible to avoid any issues with timely filing in accordance to the provider’s contract.