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REMINDER: Coordination of Benefits (COB) Claims via Electronic Data Interchange (EDI)
9/15/2022 • Posted by Provider Relations

As a reminder to our Fidelis Care providers, COB Claims can be submitted via Electronic Data Interchange (EDI) as of January 1, 2022.  This includes corrected claims and resubmissions.

 

Electronic Submission of Corrected COB Claims

  • The original claim number must be submitted 
  • The claim frequency type code must be a 7 (replacement of prior claim)
  • 2300 Loop, CLM Claim Information Segment, CLM05-3 Claim Frequency Type Code Element must be set to a 7 and 2300 Loop
  • REF Original Reference Number (ICN/DCN) Segment where REF01 Element equals F8, REF02 Element must contain Fidelis Care Original Claim Number
  • Only one correction for a Fidelis Care Original Claim Number should be submitted per day

 

Paper Submission of Corrected COB Claims:

Product

Mailing Address

Medicaid Managed Care

Child Health Plus

Fidelis Care at Home (MLTC)

HealthierLife (HARP)

Fidelis Medicaid

PO Box 10500

Farmington, MO 63640-5001

Qualified Health Plans

Essential Plan

Fidelis MarketPlace

P.O. Box 10600

Farmington, MO 63640-5002

Wellcare By Fidelis Care

  Medicare Advantage Plus

  Dual Advantage

  Medicaid Advantage Plans

Fidelis Medicare/ Wellcare By Fidelis Care

P.O. Box 10700

Farmington, MO 63640-5003

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Electronic Submission of First Time COB Claims (the claim has never been billed to Fidelis Care & where Fidelis Care is secondary for the member): 

  • Loop 2320 contains insurance information about:  Other insurance carriers and their payment information for the Subscriber being billed.
  • Segments NM1-N4 contain name and address information of the insurance carriers referenced in loop 2320.

 

Fidelis Care’s preferred clearinghouse for electronic claims submission is Availity. To enroll, please call Availity Client Services at 1-800-AVAILITY (1-800-282-4548).

Claims can also be submitted through clearinghouse Ability, or another clearinghouse. Fidelis Care offers free online claims submission through Ability’s claims portal. To learn more about Ability, call 1-888-499-5465 or visit www.mdon-line.com/fideliscare. 

You also have the option to contact another clearinghouse to initiate 837-claim submission to Fidelis Care. Please confirm with the clearinghouse that they will forward claims to Fidelis Care on your behalf.

 

COB Related Reconsiderations (the claim has previously been billed to Fidelis Care, and you are requesting a reconsideration or appeal)

  • Accepted via paper submission only at this time. 
  • Please include the following:
  • Please submit to the appropriate address below based on line of business being billed:

 

Product

Mailing Address

Medicaid Managed Care

Child Health Plus

Fidelis Care at Home (MLTC)

HealthierLife (HARP)

Fidelis Medicaid

PO Box 10500

Farmington, MO 63640-5001

Qualified Health Plans

Essential Plan

Fidelis MarketPlace

P.O. Box 10600

Farmington, MO 63640-5002

Wellcare By Fidelis Care

  Medicare Advantage Plus

  Dual Advantage

  Medicaid Advantage Plans

Fidelis Medicare/ Wellcare By Fidelis Care

P.O. Box 10700

Farmington, MO 63640-5003

               

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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Required Cultural Competency Training

Access the Provider Attestation Statement and submit completion of training.

Authorization Resources

To submit prior authorization request types, use the Fidelis Care provider portal.

Electronic Transactions

Submit claims electronically for faster processing and reimbursement.

Provider Access Online

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Utilization Management (UM)

Find information and links to external vendor authorization programs as well as links to internal Fidelis Care prior authorization resources.

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