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The following sections of the Fidelis Care authorization grids have been updated effective October 1, 2025.             The following code has been added to the Medicaid DME Authorization grid and requires prior authorization for Medicaid, Medicare, Essential Plan, and Metal-Level lines of business: L1907   Afo supramalleolar custom   The following code has been added on the Medicaid, Medicare, Essential Plan, and Metal-Level Products Authorization Grids and requires prior authorization: J9306 pertuzumab (Perjeta)   The following code has been added on the Medicaid, Essential Plan, and Metal-Level Products Authorization Grids and requires prior authorization: J9308 ramucirumab (Cyramza)   The following code has been added on the Medicaid and Metal-Level Products Authorization

Fidelis Care will host two Provider Office Hours in September 2025. During the webinars, Fidelis Care staff will be available to share information, provide an overview of provider resources, and answer your questions. Provider Office Hours – September 2025 Topic: Quality Office Hours- Clinical Documentation Improvement When:  Wednesday, September 17th – 10AM – 11AM EST Click here to register*   Topic: Fidelis Care – Back to Basics When:  Thursday, September 18th – 9AM – 10AM EST Click here to register*

To ensure timely processing and avoid delays, providers should limit all prior authorization fax transmissions to 75 pages or less. Faxes exceeding 75 pages may be delayed or fail to process, which could impact our ability to efficiently and comprehensively process the request.   Tips for Successful Fax Transmission: Assure the fax is 75 pages or less in total, including cover page. Only include information related to the specific request.   Break large documents into multiple faxes (each under 75 pages). Label each part clearly (e.g., “1 of 3,” “2 of 3,” etc.).   Fax Numbers for Utilization Management Authorization Requests: Physical Health - (800)

In an effort to streamline provider demographic changes and provider termination requests, Fidelis Care has created two new electronic forms for providers to use.  Please use these forms to submit changes under a singular TIN. In order to expedite the request, all fields on the forms are required. If not complete, the request will be delayed. Forms available on fideliscare.org: Provider Demographic Change Request Form   Provider Termination Request Form   Once completed, the forms can be submitted electronically to SMProviderAttestationUpdates@fideliscare.org. In the subject line of the email, please enter Demographic Change/Termination Request for "Your Provider/Group Name" in "Your County" (i.e. Demographic Change Request

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

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