Bienvenidos, Corredores!

Fidelis Care would like to inform providers that we are unable to accept calls from Artificial Intelligence (AI) entities or other automated systems to verify claim status, obtain remittance information, or respond to any other inquiries.  Fidelis Care representatives may only engage with a live person to verify PHI and ensure HIPAA compliance.   Providers are also encouraged to use the Fidelis Care Provider Portal to obtain needed information. For more information on the Provider Portal, please visit:  https://www.fideliscare.org/Provider/Provider-Access-Online-Resources   For additional questions, or if we can be of assistance in any way, please contact your Fidelis Care Provider Relations Specialist. To identify your designated

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 5/21/2024.  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 supplemental data by 2/1/25.  Please notify

The following sections of the Fidelis Care authorization grids have been updated effective August 1, 2024.   The following code has been added on the DME Authorization Grid: E1815  Dynamic adjustable ankle extension/flexion device, includes soft interface material   Evolent Oncology Program (New Century Health) will require review of the following codes for Medicaid, Medicare, Essential Plans and Metal-Level Products: J8999    iptacopan oral J8999    tovorafenib oral J8999    tovorafenib oral suspension J9999    docetaxel (Docivyx) J9999    tarlatamab J9999    trastuzumab-strf injection   Evolent Oncology Program (New Century Health) will require review of the following codes for Medicaid, Essential Plans and Metal-Level Products: J9393    fulvestrant (Teva)   Evolent Oncology Program (New Century Health) will require review of the following codes

Fidelis Care is implementing changes to our Peer-to-Peer process.   Due to CMS regulations, Fidelis Care is introducing a new Medicare procedure, effective immediately. We will no longer provide a Post-Decision Peer-to-Peer review for services pertaining to Medicare members. It is important to note that submitting a formal appeal will be necessary for any post-decision reviews.   For all other lines of business, Fidelis Care will continue to offer Peer-to-Peer reviews, which may result in a reversal of the initial decision based on the information provided as part of the Peer-to-Peer review. It is important to note that all Peer-to-Peer requests must be submitted

Fidelis Care will host two Provider Office Hours in July 2024. During the webinar, Fidelis Care staff will be available to share information, explain different resources, and answer your questions. Provider Office Hours – July 2024 Topic: Back to Basics – Doing Business with Fidelis Care When:  Thursday, July 11th – 12PM – 1PM EST Click here to register*   Topic: Fidelis Care Quality Programs When:  Thursday, July 25th – 2PM – 3PM EST Click here to register*