Career Events

Fidelis Care would like to make you aware new explanation codes you may see on remittances for Wellcare By Fidelis Care Dual Access members:   Explanation Code        918 - Member Liability The member is responsible for these out-of-pocket cost share amounts. 919 - Non-Billable Cost Share Do Not Bill Member; for this scenario the member is not liable for the cost share as the amount paid to the provider meets the contractual reimbursement. 920 - Bill Cost Share to Medicaid For this scenario, the associated cost share needs to be billed

Fidelis Care will host two Provider Office Hours in May 2024. During the webinar, Fidelis Care staff will be available to share information, explain different resources, and answer your questions. Provider Office Hours – May 2024 Topic: Back to Basics – Doing Business with Fidelis Care When:  Thursday, May 9th – 12PM – 1PM EST Click here to register*   Topic: Utilization Management When:  Thursday, May 23rd – 9AM – 10AM EST Click here to register* *Attendance will

Fidelis Care would like to inform providers about upcoming changes to our remittance advice.  Effective May 12, 2024, the Fidelis Care remittance advice will include Claim Adjustment Reason Codes (CARC) and Remittance Advice Remark Codes (RARC), along with a description of the codes.   CARCs describe why a claim or service line was paid differently than it was billed and RARCs provider additional explanation for an adjustment already described by a CARC or convey information about remittance advice.    There are two types of RARCs, supplemental and informational.  The majority of RARCs are supplemental; these are generally referred to as RARCs without further distinction. 

Fidelis Care is pleased to inform you that the most recent 2024 QARR/HEDIS Care Gap Report has been posted on Provider Access Online (provider portal). This information is indicative of all encounter data on file with Fidelis Care as of 03/20/2024.  This report provides you with the opportunity to review preventative services for which Fidelis does not show your members as receiving in the measurement period.  We strongly suggest that you review the report for opportunities to either render the service, schedule the service to be done before 12/31/24 or if previously performed, submit supplemental data by 2/1/25.  Please notify

Grants of $10,000 to $20,000 aimed at improving behavioral health outcomes, especially in underserved communities   Deadline to apply is 5 p.m. EDT May 31, 2024   LONG ISLAND CITY, NY (May 1, 2024) In observance of Mental Health Awareness Month, Fidelis Care, a statewide health plan with more than 2.4 million members in New York State and a wholly owned subsidiary of Centene Corporation, has opened the application process for its 2024 behavioral health grant program. The grants range from $10,000 to $20,000 each and are aimed at assisting providers and community-based organizations that support behavioral health and wellness, especially in underserved communities.

Fidelis Care is pleased to announce that a new Provider Bulletin is now available. The bulletin features updates on important initiatives and the latest news of interest to our provider community. Articles in this issue: Behavioral Health Grant Applications Now Open How to Contact Your Provider Relations Specialist New Claims Dispute Functionality in the Provider Portal Important Reminders About HIV Prevention and Testing Introducing New Behavioral Health Program (METS)   Please download Fidelis Care Provider Bulletin – Volume 10, Issue 2.   To view our Provider Bulletin Library, please visit: Provider Bulletins.

The following sections of the Fidelis Care authorization grids have been updated effective June 1, 2024.   The following codes have been added on the Medicaid, Medicare, Essential Plan, and Metal-Level Products Authorization Grids and require prior authorization: J0209    sodium thiosulfate (Hope) J1434    fosaprepitant (Focinvez)   The following codes have been added to the Medicaid DME Authorization Grid and require prior authorization: E0468     Home ventilator, dual-function respiratory device, also performs additional function of cough stimulation, includes all accessories, components and supplies for all functions E2298     Complex rehabilitative power wheelchair accessory, power seat elevation system, any type K1037     Docking station for use with oral device/appliance used to reduce