Patient Eligibility and Benefits Status Will Transition to Self-Service Function on August 15, 2022
7/12/2022
•
Posted by Provider Relations
Beginning August 15, 2022, all Fidelis Care providers inquiring about a patient’s eligibility and benefits will need to use either the Patient Search tool on Fidelis Care’s Provider Portal, Provider Access Online, or the Automated Eligibility system on our Interactive Voice Response (IVR) at 1-888-FIDELIS (1-888-343-3547).
By using either of these tools, your staff can quickly and easily learn a patient’s eligibility and benefits, without any wait times.
Eligibility and benefits information will no longer be available by contacting the Call Center.
To help ease this transition, Fidelis Care recommends your office staff review our Provider Access Online resources, including new video tutorials, at fideliscare.org/PAO.
Account Administrators should also use this time to look over the level of access given to staff and adjust accordingly. To perform a Patient Search, staff members need to be granted Patient Information Viewer access. Visit fideliscare.org/PAO for more information on managing Provider Access Online user roles.
To check a patient’s eligibility and benefits:
After signing in, click on Patient in the left navigational menu, and then select how you want to search for your patient. You can use any of the following search functions:
- Subscriber ID
- Medicaid ID/CIN
- Medicare ID
- Social Security Number
- Name and Date of Birth
Once you enter the requested information and the As-Of-Date, you will quickly see the Patient Details overview if the patient is a Fidelis Care or Wellcare By Fidelis Care member. Click on the patient’s name for full details, including Eligibility and Benefits.
Check Eligibility: Confirm the patient’s eligibility by product in the Eligibility section, including his/her effective date of coverage.
Check Benefits: The Benefits section provides a detailed, searchable list of the different services available to the patient, displaying important information such as covered benefits, network status, copayment, coinsurance, benefit limit, and deductible.
Provider Access Online, Fidelis Care’s Provider Portal, is an easy-to-use, secure, self-service platform that provides your office with 24/7 access to authorizations status, claims status, patient eligibility, plan benefits, and more.
If you have any additional questions regarding the self-service Eligibility and Benefits process, please contact our Provider Call Center at 1-888-FIDELIS (1-888-343-3547) or your local Provider Relations Specialist.