Bienvenidos, Corredores!

Fidelis Care is pleased to announce another new functionality in the Provider Portal, allowing providers to submit authorization appeals electronically.  With this easy-to-use new tool, providers are able to submit inpatient and outpatient prior authorization appeals.

To Submit an Authorization Appeal:

1. Log in to the Fidelis Care Provider Portal with your User ID and Password.

Please note: Users will need Authorizations Viewer or Account Administration user roles to access authorization information.

2. Select Authorization Status located on the menu on the left side of the page.
3. On the Authorization Search page, click on Search All Authorizations. You can search by Subscriber ID, Authorization #, Medicaid ID, Medicare ID, SSN, or Name & DOB.
4. Click on the Authorization you would like to appeal.
5. At the bottom of the Authorization Form Page, Click Request Auth Appeal. The Outpatient or Inpatient Authorization Status needs to be selected to request an appeal.
6. On the Appeal Request Form page, you can look at all of the codes included on the authorization, by clicking on the green arrow below Authorization History.
7. Under Appeal Details, provide the primary contact person and phone number for the requested appeal. 
8. Under Rationale, please list any specific codes and rationale you want Fidelis Care to consider for the appeal. 
9. You will also need to submit any supporting documentation for the appeal under Evidence Files.
10. When all fields have been completed, click Review and Submit Appeal.
11. Once your appeal has been submitted, you will receive a message at the top of the screen, showing your appeal has been successfully submitted.  If an Authorization Appeal Request already has an appeal on file, another appeal cannot be submitted.
12. Check for the status of the Authorization Appeal, by looking up the authorization from the Authorization Status menu. While the authorization appeal is in review, the status will show as Open and the decision will show Pending.  Your appeal status will show as Closed once an appeal decision has been made. 

For more detailed instructions please use the following resource guides:

• Provider Access Online resources, including a new video tutorial

• Provider Portal User Guide - Authorization Appeals QRG

For additional questions, or if we can be of assistance in any way, please contact your Fidelis Care Provider Relations Specialist. To find your designated representative, please visit Contact Your Designated Provider Relations Specialist.