Welcome, Providers!

You asked and we listened!  Fidelis Care is pleased to announce a new functionality in the Provider Portal, allowing providers to submit  claims disputes electronically.  With this easy-to-use new tool, providers are able to submit COB resubmissions, claims appeals, or claims reconsiderations.

To submit a claim dispute:

1. Log in to the Fidelis Care Provider Portal with your User ID and Password.

Please note: Users will need Claims Information Viewer or Account Administration user roles to access claims information.

2. Select Claims located in the menu on the left side of the page under External Links.

3. On the Claims page, you can search by Subscriber ID, Claim ID, Medicaid ID, Medicare ID, Patient Account Number, or Provider NPI. Include a date range for the search.

4. Click on the Claim ID you would like to dispute.

5. Under the Payment Heading, Click Dispute Claim.

6. Choose the Dispute Type you would like to submit. Choices include COB Resubmissions, Appeal, or Reconsideration.

7. Choose the COB Resubmission/Appeal/Reconsideration Type from the drop-down menu, provide a brief explanation of the dispute in the Notes/Brief Explanation Field, and upload any supporting documentation in the Upload Documents Field. Then, click Submit Request.

8. Once your dispute has been submitted you will receive a message at the top of the screen, showing your dispute has been successfully submitted.
   1. While the dispute is in review, the status will show as Open or Pending.

9. A number will generate under Submitted for Appeal. Check for status updates in the Claims Info section.
   1. Please do not submit more than one dispute per claim at any one time..
   2. Your dispute status will show as Resolved once an appeal decision has been made under the Claim Info heading.  Resolved means the original claim decision has been upheld or the claim will be adjusted.

For more detailed instructions please use the following resource guides:

• Provider Access Online resources, including a new video tutorial

• Provider Portal User Guide - Claims Appeals QRG

For additional questions, or if we can be of assistance in any way, please contact your Fidelis Care Provider Relations Specialist. To find your designated representative, please visit Contact Your Designated Provider Relations Specialist.