Welcome, Brokers!

The following sections of the Fidelis Care authorization grids have been updated effective November 1, 2024.   The following codes have been added to the Medicaid DME Authorization Grid:   A4543 Supplies for transcutaneous electrical nerve stimulator, for nerves in the auricular region, per month A4544 Electrode for external lower extremity nerve stimulator for restless legs syndrome

Fidelis Care would like to inform providers of Medicaid requirements when medical records are lost due to an unforeseen event.  Providers whose records have been damaged, lost, or destroyed are required to report that information as soon as practicable, but no later than thirty calendar days after discovery, to the New York State (NYS) Office of the Medicaid Inspector General (OMIG) Self-Disclosure Unit. Failure to report such incidents may result in a determination of overpayment, penalties, and/or sanctions. Please note: Loss/destruction/ corruption/inaccessibility of electronic records due to data corruption, theft, change in data vendor or other issues must also be included

Fidelis Care would like to remind providers of claim submission guidelines regarding Coordination of Benefits (COB) for Child Health Plus, Essential Plan, and Metal-Level products.   Child Health Plus: In accordance with the terms of the Subscriber Contract for Child Health Plus, no coordination of benefits will occur for claims submitted when another carrier is primary. This includes Medicare, any other governmental program, commercial or self-funded policies.   Essential Plan and Health Benefit Exchange: In accordance with the terms of the Subscriber Contracts for the Essential Plan and Health Benefit Exchange, no coordination of benefits will occur for claims submitted when Medicare or any other

Fidelis Care will host our Quality Provider Office Hours on September 24, 2024. During the webinar, Fidelis Care staff will be available to share information, explain different resources, and answer your questions. Quality Provider Office Hours – September 2024   Topic: Fidelis Care and Wellcare Quality Programs When:  Tuesday, September 24th – 2PM – 3PM EST Click here to register*   *Attendance will be limited to the first 300 registrants for each session.   The Quality session will

Provider Access Online, Fidelis Care’s Provider Portal, is an easy-to-use, secure, self-service platform that provides your office with 24/7 access to the patient information you need - from authorizations and claims status, to eligibility, plan benefits, and more.   Our Portal saves valuable time for your administrative staff and provides the answers and resources you’re looking for - any time, on demand.   Use the Portal to: Follow claims and authorizations status in real time; and Access patient rosters, remittances, quality reports, and downloadable letters, including: Admission Approval Letter Appeal Approved and Out-Of-Network Denied Letter Appeal Decision Letter Appeal Denial Decision Letter Approval Letter