REMINDER: Mailing Addresses for Appeals, Reconsiderations, and Corrected Claims
3/22/2023
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Posted by Provider Relations
As a reminder to our Fidelis Care providers, please use the mailing addresses below when submitting paper appeals, reconsiderations, and corrected claims. Using these addresses will help Fidelis Care process your claims more quickly and efficiently.
| Re-Submission Type | Fidelis Care Line of Business | Mailing Address |
| Corrected Claims with Third-Party EOB's Attached* | 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 |
| Medicare Advantage
Dual Advantage
Medicaid Advantage Plans | Fidelis Medicare
P.O. Box 10700
Farmington, MO 63640-5003 |
| All Other Claims* | All | Fidelis Care
Attn: Corrected Claims
480 Crosspoint Parkway
Getzville, New York 14068 |
| Claim Administrative Reconsiderations
Claim Appeals
Adjustments
Claim Invoices | Medicaid Managed Care
Child Health Plus
Fidelis Care at Home (Managed Long Term Care)
HealthierLife (Health and Recovery Plan) | Fidelis Medicaid
P.O. Box 10500
Farmington, MO 63640-5001 |
| Qualified Health Plans
Essential Plan | Fidelis Marketplace
P.O. Box 10600
Farmington, MO 63640-5002 |
| Medicare Advantage
Dual Advantage
Medicaid Advantage Plus | Fidelis Medicare
P.O. Box 10700
Farmington, MO 63640-5003 |
* Providers are strongly encouraged to submit corrected claims electronically. Please see below for detailed instructions.
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.
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
Electronic Submission of Corrected 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