El blog de Fidelis Care

Fidelis Care would like to announce a new Explanation of Benefit (EOB) adjustment reason code that will be applied to claims where Fidelis Care has received a primary carrier payment. New EOB Reason Code Details: CARC Code: 216 – Based on the findings of a review, organization or the payer’s findings. RARC Code: N199 – Additional payment/recoupment approved based on payer-initiated review/audit. These are internal adjustments that reflect the primary carrier’s payment. They do not impact the provider’s Remittance Advice financially and are not considered recoupments.   Primary Carrier Billing and Payments: Medicaid is the payer of last resort and should always be

  Cada agosto celebramos la Semana Nacional de los Centros de Salud para reconocer a las personas y lugares que ayudan a mantener sanas a nuestras comunidades. Los centros de salud son más que clínicas, son vecinos de confianza que ofrecen atención completa a millones de familias, sin importar cuáles son sus ingresos o su origen.

As part of our ongoing Payment Integrity Program, a new initiative will begin September 1, 2025. This program involves review of the medical records associated with an identified inpatient claim to ensure that the documentation in the medical record fully supports the diagnosis and procedure codes that were billed.   What to Expect: Claims selected for review will be reflected as denied on the Remittance Advice with reason code 602 – Medical record required for DRG validation. You will receive a letter from Cotiviti requesting the medical records related to the denied claim(s). The letter will specify the required documentation needed to complete the review and the timeframe

The following section of the Fidelis Care authorization grids have been updated effective September 1, 2025.   The following code has been updated on the Medicare Authorization Grid and requires prior authorization:   Durable Medical Equipment/Supplies:            E1012 Wheelchair accessory, addition to power seating system, center mount power elevating leg rest/platform, complete system, any type, each   The following section of the Fidelis Care authorization grids have been updated effective July 1, 2025.   The following codes have been updated on the Medicare Authorization Grid and no longer require prior authorization:   Service Category Services

  Agosto es el “Mes de la alimentación saludable infantil”. Es un mes para incentivar a los niños a crear hábitos saludables que puedan seguir toda su vida. Comienza el año escolar y las rutinas cambian. Por eso, es el momento justo para detenerse y observar qué están comiendo nuestros hijos, y cómo podemos ayudarlos. Una alimentación saludable no se trata solo de reglas estrictas o comidas “perfectas”. Se trata de crear un enfoque equilibrado en los alimentos que nutren el cuerpo y la mente de nuestros hijos, una comida (¡y un refrigerio!) a la vez.