2025/8/6
• Posted by Provider Relations
• in
Provider News
Availity experts are hosting several live webinar sessions in the month of August to assist Fidelis Care providers with navigation of Availity Essentials. Space is limited, save your seat today!
Topic
Webinar Date
Availity Essentials Introduction
Monday, August 11th, 3:00 - 4:00 pm EST
Authorization Tools
2025/8/1
• Posted by Provider Relations
• in
Provider News
The following section of the Fidelis Care authorization grids have been updated effective September 1, 2025.
The following code has been updated on the Medicare Authorization Grid and requires prior authorization:
Durable Medical Equipment/Supplies:
E1012 Wheelchair accessory, addition to power seating system, center mount power elevating leg rest/platform, complete system, any type, each
The following section of the Fidelis Care authorization grids have been updated effective July 1, 2025.
The following codes have been updated on the Medicare Authorization Grid and no longer require prior authorization:
Service Category
Services
2025/8/1
• Posted by Dr. Nicole Belanger-Reynolds, Medical Director
• in
Caregiver Support,
Children's Health,
Health and Wellness
八月是「兒童合理飲食月」。這是一個鼓勵孩子們培養能持續一生的健康習慣的時刻。隨著新學年臨近，日常安排也在變化，這正是我們停下來仔細審視孩子們的飲食 - 以及如何更好地支持他們的絕佳時機。
健康飲食並非指嚴格的規定或「完美」的膳食。而是關於建立一種均衡的飲食方式，為孩子們的身心提供能量 - 就從每一餐（還有每一份零食！）開始。
2025/8/1
• Posted by Provider Relations
• in
Provider News
As part of our ongoing Payment Integrity Program, a new initiative will begin September 1, 2025. This program involves review of the medical records associated with an identified inpatient claim to ensure that the documentation in the medical record fully supports the diagnosis and procedure codes that were billed.
What to Expect:
Claims selected for review will be reflected as denied on the Remittance Advice with reason code 602 – Medical record required for DRG validation.
You will receive a letter from Cotiviti requesting the medical records related to the denied claim(s).
The letter will specify the required documentation needed to complete the review and the timeframe
2025/8/1
• Posted by Provider Relations
• in
Provider News
Fidelis Care would like to announce a new Explanation of Benefit (EOB) adjustment reason code that will be applied to claims where Fidelis Care has received a primary carrier payment.
New EOB Reason Code Details:
CARC Code: 216 – Based on the findings of a review, organization or the payer’s findings.
RARC Code: N199 – Additional payment/recoupment approved based on payer-initiated review/audit.
These are internal adjustments that reflect the primary carrier’s payment. They do not impact the provider’s Remittance Advice financially and are not considered recoupments.
Primary Carrier Billing and Payments:
Medicaid is the payer of last resort and should always be
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