Yesterday
• Posted by Provider Relations
Fidelis Care would like to remind our providers of a claim denial reason code that is used when COB claim resubmission requirements are not met.
EX CODE: 50M
Short Description: Claim resubmission requirements not met
Long Description: COB resubmission requirements not met - missing resubmission code and/or reconsideration form
The denial reason will occur when providers do not indicate the appropriate resubmission code or do not include the reconsideration form. This denial reason code is specific to COB claims that have been resubmitted to Fidelis Care.
In order to avoid this denial, please follow the instructions below for claim corrections and reconsiderations:
Electronic Submission of Corrected
Wednesday
• Posted by Provider Relations
September is National Substance Use Prevention Month, a time to raise awareness, reduce stigma, and promote prevention, harm reduction, treatment, and recovery resources for individuals and families affected by substance use disorders.
Substance use disorders impact millions of people each year, affecting individuals, families, workplaces, and communities. Prevention begins with education, early intervention, and ensuring that people know help is available when they need it. By encouraging open conversations and increasing access to care, we can help prevent substance misuse and support individuals on their recovery journey.
Harm Reduction Saves Lives
Harm reduction is an evidence-based approach that focuses on reducing the negative
Last Week
• Posted by Provider Relations
The HEDIS® behavioral health F-series measures focus on timely transitions of care following behavioral health and substance use-related hospitalizations or emergency department visits. These measures highlight the importance of connecting members to follow-up care within 7 days to support recovery and improve outcomes.
They include:
• Follow-Up After Hospitalization for Mental Illness (FUH)
• Follow-Up After Emergency Department Visit for Mental Illness (FUM)
• Follow-Up After High-Intensity Care for Substance Use Disorder (FUI)
• Follow-Up After Emergency Department Visit for Substance Use (FUA)
The days immediately following discharge are critical. Without timely follow-up, members may experience worsening symptoms, challenges with treatment adherence, or an increased risk
Last Week
• Posted by Provider Relations
Depression is one of the most common behavioral health conditions affecting adolescents and adults, yet many individuals remain undiagnosed and untreated. The Depression Screening and Follow-Up for Adolescents and Adults (DSF-E) measure highlights the importance of screening members for depression and ensuring appropriate follow-up when a screening result is positive.
Primary Care Providers are often the first point of contact for members and play a critical role in identifying behavioral health concerns early. Providers are encouraged to incorporate depression screening into every annual wellness visit, particularly for adolescents and young adults, as early identification can lead to timely intervention and improved
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