As your health plan partner, Fidelis Care would like to inform you of the following updates to help ensure accuracy in claims submissions.
For COB Submissions Received without Claims Attached:
Effective on August 1, 2019, Coordination of Benefits (COB) adjustment requests or appeal submissions without a claim form attached (CMS 1500 or UB04) will be rejected and returned with a request for resubmission with a valid claim form. Providers must also use the Provider Reconsideration/Appeal Form, when appealing a claims adjudication decision, which is easily accessible on the Provider Portal. You may access the form here: Provider Appeals Form
These key steps are included in your current Fidelis Care Provider Manual, but have not been followed consistently. To ensure timeliness and accuracy, we will adhere to these standards going forward.