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HomeBlog | Fidelis Care

The Fidelis Care Blog


REMINDER: Mailing Addresses for Appeals, Reconsiderations, and Corrected Claims
3/22/2023 • Posted by Provider Relations in Provider News

As a reminder to our Fidelis Care providers, please use the mailing addresses below when submitting paper appeals, reconsiderations, and corrected claims. Using these addresses will help Fidelis Care process your claims more quickly and efficiently.

 

 

Re-Submission Type

  

Fidelis Care Line of Business

  

Mailing Address
 

Corrected Claims with Third-Party EOB's Attached*

  

Medicaid Managed Care

Child Health Plus

Fidelis Care at Home (MLTC)

HealthierLife (HARP)

  

Fidelis Medicaid

PO Box 10500

Farmington, MO 63640-5001
 

Qualified Health Plans

Essential Plan

  

Fidelis MarketPlace

P.O. Box 10600

Farmington, MO 63640-5002
 

Medicare Advantage

Dual Advantage

Medicaid Advantage Plans

  

Fidelis Medicare

P.O. Box 10700

Farmington, MO 63640-5003
 

All Other Claims*

  

All

  

Fidelis Care

Attn: Corrected Claims

480 Crosspoint Parkway

Getzville, New York 14068
 

Claim Administrative Reconsiderations

Claim Appeals

Adjustments

Claim Invoices

  

Medicaid Managed Care

Child Health Plus

Fidelis Care at Home (Managed Long Term Care)

HealthierLife (Health and Recovery Plan)

  

Fidelis Medicaid

P.O. Box 10500

Farmington, MO 63640-5001
 

Qualified Health Plans

Essential Plan

  

Fidelis Marketplace

P.O. Box 10600

Farmington, MO 63640-5002
 

Medicare Advantage

Dual Advantage

Medicaid Advantage Plus

  

Fidelis Medicare

P.O. Box 10700

Farmington, MO 63640-5003

* Providers are strongly encouraged to submit corrected claims electronically.  Please see below for detailed instructions.

Electronic Submission of First Time COB Claims (the claim has never been billed to Fidelis Care & where Fidelis Care is secondary for the member): 


  • Loop 2320 contains insurance information about:  Other insurance carriers and their payment information for the Subscriber being billed.

  • Segments NM1-N4 contain name and address information of the insurance carriers referenced in loop 2320.

Electronic Submission of Corrected COB Claims

  • The original claim number must be submitted 

  • The claim frequency type code must be a 7 (replacement of prior claim)

  • 2300 Loop, CLM Claim Information Segment, CLM05-3 Claim Frequency Type Code Element must be set to a 7 and 2300 Loop

  • REF Original Reference Number (ICN/DCN) Segment where REF01 Element equals F8, REF02 Element must contain Fidelis Care Original Claim Number

  • Only one correction for a Fidelis Care Original Claim Number should be submitted per day

Electronic Submission of Corrected Claims


  • The original claim number must be submitted 

  • The claim frequency type code must be a 7 (replacement of prior claim)

  • 2300 Loop, CLM Claim Information Segment, CLM05-3 Claim Frequency Type Code Element must be set to a 7 and 2300 Loop

  • REF Original Reference Number (ICN/DCN) Segment where REF01 Element equals F8, REF02 Element must contain Fidelis Care Original Claim Number

  • Only one correction for a Fidelis Care Original Claim Number should be submitted per day

 

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REMINDER: Mailing Addresses for Appeals, Reconsiderations, and Corrected Claims
3/22/2023 • Posted by Provider Relations

As a reminder to our Fidelis Care providers, please use the mailing addresses below when submitting paper appeals, reconsiderations, and corrected claims. Using these addresses will help Fidelis Care process your claims more quickly and efficiently.

 

 

Re-Submission Type

  

Fidelis Care Line of Business

  

Mailing Address
 

Corrected Claims with Third-Party EOB's Attached*

  

Medicaid Managed Care

Child Health Plus

Fidelis Care at Home (MLTC)

HealthierLife (HARP)

  

Fidelis Medicaid

PO Box 10500

Farmington, MO 63640-5001
 

Qualified Health Plans

Essential Plan

  

Fidelis MarketPlace

P.O. Box 10600

Farmington, MO 63640-5002
 

Medicare Advantage

Dual Advantage

Medicaid Advantage Plans

  

Fidelis Medicare

P.O. Box 10700

Farmington, MO 63640-5003
 

All Other Claims*

  

All

  

Fidelis Care

Attn: Corrected Claims

480 Crosspoint Parkway

Getzville, New York 14068
 

Claim Administrative Reconsiderations

Claim Appeals

Adjustments

Claim Invoices

  

Medicaid Managed Care

Child Health Plus

Fidelis Care at Home (Managed Long Term Care)

HealthierLife (Health and Recovery Plan)

  

Fidelis Medicaid

P.O. Box 10500

Farmington, MO 63640-5001
 

Qualified Health Plans

Essential Plan

  

Fidelis Marketplace

P.O. Box 10600

Farmington, MO 63640-5002
 

Medicare Advantage

Dual Advantage

Medicaid Advantage Plus

  

Fidelis Medicare

P.O. Box 10700

Farmington, MO 63640-5003

* Providers are strongly encouraged to submit corrected claims electronically.  Please see below for detailed instructions.

Electronic Submission of First Time COB Claims (the claim has never been billed to Fidelis Care & where Fidelis Care is secondary for the member): 


  • Loop 2320 contains insurance information about:  Other insurance carriers and their payment information for the Subscriber being billed.

  • Segments NM1-N4 contain name and address information of the insurance carriers referenced in loop 2320.

Electronic Submission of Corrected COB Claims

  • The original claim number must be submitted 

  • The claim frequency type code must be a 7 (replacement of prior claim)

  • 2300 Loop, CLM Claim Information Segment, CLM05-3 Claim Frequency Type Code Element must be set to a 7 and 2300 Loop

  • REF Original Reference Number (ICN/DCN) Segment where REF01 Element equals F8, REF02 Element must contain Fidelis Care Original Claim Number

  • Only one correction for a Fidelis Care Original Claim Number should be submitted per day

Electronic Submission of Corrected Claims


  • The original claim number must be submitted 

  • The claim frequency type code must be a 7 (replacement of prior claim)

  • 2300 Loop, CLM Claim Information Segment, CLM05-3 Claim Frequency Type Code Element must be set to a 7 and 2300 Loop

  • REF Original Reference Number (ICN/DCN) Segment where REF01 Element equals F8, REF02 Element must contain Fidelis Care Original Claim Number

  • Only one correction for a Fidelis Care Original Claim Number should be submitted per day