7/31/2023
• Posted by Provider Relations
Fidelis Care is pleased to inform you that the most recent 2023 QARR Non-Compliance 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 6/20/2023. Please refer to the most recent "Non-Compliance Report" instruction letter to understand the information being provided on each tab of the Excel Spreadsheet. Please notify any staff involved with quality management and advise that these documents have been posted. If you have any questions, please call the Provider Call Center at 1-888-FIDELIS (1-888-343-3547).
7/31/2023
• Posted by Provider Relations
The following sections of the Fidelis Care authorization grids have been updated effective September 1, 2023.
The Medicaid, Medicare, Essential Plan and Metal-Level grids have been updated as follows:
II. Inpatient Admissions: All inpatient admissions require an authorization.
Fidelis Care does not require authorization of emergency room services or any emergent service required to provide stabilization of an emergent condition. Fidelis Care does require authorization of post stabilization services and inpatient admissions after emergency room services are completed. All facility admissions are reviewed for medical necessity. Note: New fax number for Inpatient ER is 833-663-1602 (formerly 347-868-6411).
III. Outpatient surgery: The following services
7/28/2023
• Posted by Provider Relations
Fidelis Care would like to notify our providers of an update to our Applied Behavior Analysis (ABA) Clinical Policy.
Effective October 1, 2023, ABA services are not covered by Fidelis Care when provided in a school setting and the site of service must be identified in connection with a service authorization request.
ABA treatment cannot be requested for services that are otherwise covered under the Individuals with Disabilities Education Act (IDEA) or provided in an educational or school-based setting. If medically necessary, supplemental ABA services can occur in coordination with educational services and plans.
Place of Service Code “03”
Effective October 1, 2023, claims
7/26/2023
• Posted by Provider Relations
Medicaid covers the transportation of eligible, enrolled persons who need transportation to and from Medicaid-covered services. When traveling to medical appointments Medicaid enrollees are expected to use the same mode of transportation used to carry out daily activities. In some instances, an enrollee’s medical condition necessitates a specific mode of transportation such as taxi/livery, ambulette, or ambulance. The Medicaid Transportation program will pay for the lowest cost, most medically appropriate mode of transportation as justified by an enrollee’s medical provider.
As of June 6, 2022, the Form-2015 must be submitted through the transportation manager’s online portal. Forms submitted through any other
7/20/2023
• Posted by Provider Relations
In order to notify providers of Utilization Management (UM) activity in an expedient manner, Fidelis Care would like to remind providers that messages may only be left for providers if the provider’s voicemail box is HIPAA complaint.
Voicemail Requirements –Mailbox greetings need to specifically identify the owner of the mailbox, the name of the owner’s organization, and state that the mailbox is confidential and Personal Health Information (PHI) can be left.
If these requirements are met, a detailed message will be left. If the voicemail box is not deemed HIPAA compliant, the UM department will leave a generic message and request a
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