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Reminder Claim Submissions
9/27/2019 • Posted by Provider Relations

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.

eviCore Healthcare

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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


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