Welcome, Providers!

 

LATEST NEWS


Fidelis Care Authorization Grids Effective September 1, 2019
8/2/2019 • Posted by Provider Relations

The following sections of the Fidelis Care authorization grids have been updated
effective September 1, 2019.

The following services apply to all lines of business and require or exclude prior authorization as noted:

IV. or V.   Outpatient and DME Services
                   2.  Note:  Authorization is not required for CPT 81220, 81329 and 81336. 
                         CPT 81220 has a lifetime limit of 1. CPT 81329 and 81336 have a
                         combined limit of 1 per lifetime.

IX.  Pharmacy:  (no changes to the Medicare grid)
                   B.  This code requires authorization:
                         Q3028 interferon beta-1a, SC (Rebif) (added)

                   Note:  The pharmacy code description has been added to each code.   

Visit:  Authorization Grids

eviCore Healthcare

Access the eviCore utilization management system.

Electronic Transactions

Submit claims electronically with Fidelis Care.

Join Our Provider Network

Be part of the Fidelis Care mission. 

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

Verify member eligibility, check claims status, and more.

Provider Bulletin

Read the latest Provider Bulletin and browse the archives.

Manuals and Forms

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