Welcome, Brokers!

Fidelis Care would like to remind providers of CMS correct coding guidelines to prevent billing errors and potential audits.  Fidelis Care has found instances where claims for the same service were billed multiple times using the same revenue code.  Per CMS guidelines, providers must ensure that each service charge has a distinct revenue code.   Reference Material Centers for Medicare & Medicaid Services (Chapter 1/ Subsection 120.3 - Suspect Duplicates, Page 261 and 263) - Click Here   If you have any questions, please contact your Fidelis Care Provider Engagement Account Manager. To find your designated representative, please visit Contact Your Designated Provider Relations Specialist.  

Fidelis Care is pleased to announce that a new Provider Bulletin is now available. The bulletin features updates on important initiatives and the latest news of interest to our provider community. Articles in this issue: Fidelis Care Provider Portal and Availity Essentials Transition Encourage Patients to Get Screened for Hepatitis C Family Planning and Reproductive Healthcare Prevent Lead Poisoning The Importance of Domestic Violence Screening    Please download Fidelis Care Provider Bulletin – Volume 11, Issue 1.   To view our Provider Bulletin Library, please visit: Provider Bulletins.

Fidelis Care is pleased to announce that the new Quality Care Incentives (QCI) Program is now available on Provider Access Online. Once logged in, please navigate to the File Downloads section to access the brochure.   Fidelis Care is committed to ensuring that our members have access to essential preventive services that promote overall well-being and enhance their quality of life. As a contracted provider with Fidelis Care, your role is vital in helping us achieve this commitment.   For over 25 years, Fidelis Care has provided incentive payments to participating providers for delivering routine preventive care and promoting health among members. The organization remains dedicated

Fidelis Care is pleased to inform you that the most recent 2024 QARR/HEDIS Care Gap 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 12/10/2024.  This report provides you with the opportunity to review preventative services for which Fidelis does not show your members as receiving in the measurement period.  We strongly suggest that you review the report for opportunities to either render the service, schedule the service to be done before 12/31/24 or if previously performed, submit medical record supplemental data by 2/1/25. 

Beginning March 1, 2025, all Fidelis Care providers inquiring about authorization requirements will need to use the Authorization Grids and the Authorization Requirement Lookup Tool available on fideliscare.org. The Authorization Requirement Lookup tool will help providers determine which procedure codes require pre-authorization for Medicaid (including Child Health Plus and HARP products), Medicare, Essential Plans, and Qualified Health Plans (Ambetter from Fidelis Care).  Authorization requirements will no longer be available by contacting the Call Center.    Streamlined Access for Providers: Access the lookup tool on fideliscare.org: Navigate to Providers Under Provider Resources, find Authorization Resources then Authorization Grids Click on the Medicaid, Child