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Stay informed about Fidelis Care policies and updates, and keep up to date on upcoming provider office hours and trainings.
Do you need assistance? Please visit our Contact Provider Relations page to find your designated Provider Relations Specialist.
Fidelis Care is implementing changes to our Peer-to-Peer process.
Due to CMS regulations, Fidelis Care is introducing a new Medicare procedure, effective immediately. We will no longer provide a Post-Decision Peer-to-Peer review for services pertaining to Medicare members. It is important to note that submitting a formal appeal will be necessary for any post-decision reviews.
For all other lines of business, Fidelis Care will continue to offer Peer-to-Peer/Reconsideration reviews, which may result in a reversal of the initial decision based on the information provided as part of the Peer-to-Peer/Reconsideration review. It is important to note that all Peer-to-Peer/Reconsideration requests must be submitted within five (5) business days of the initial determination date, and can only be submitted before a formal appeal is requested. After this period, a formal appeal will be required for review and reconsideration of the initial determination. Please note that a formal appeal can be submitted at any time after the initial determination is made, within the allotted regulatory appeal timeframes for the member’s line of business.
For additional questions, or if we can be of assistance in any way, please contact your Fidelis Care Provider Relations Specialist. To identify your designated representative, please visit Contact Your Designated Provider Relations Specialist.
Assisting providers in staying abreast of the latest trends, policies, and studies.
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Volume 10, Issue 1
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To submit prior authorization request types, use the Fidelis Care provider portal.
Members in our Medicaid Managed Care, HealthierLife (HARP), Fidelis Care at Home, and Wellcare Fidelis Dual Plus plans have access to a network of service providers to identify and address needs such as housing, food, transportation, and more.
Apply to our network and become a part of the Fidelis Care mission.