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Fidelis Care has been notified that the MCG Cite Guideline Transparency Tool will be upgraded to the 28th edition effective Friday, May 17, 2024. Providers can access this tool through the Fidelis Care Provider Portal. The Summary of Changes can be accessed from the main search page or any content product table of contents on the MCG website.  In addition, providers can review the Summary of Changes for the 28th edition content release. As a reminder, with the MCG Cite Guideline Transparency Tool, Fidelis Care can share clinical indications with providers. The tool is a secure resource that helps meet regulations around transparency

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

Fidelis Care would like to make you aware new explanation codes you may see on remittances for Wellcare By Fidelis Care Dual Access members:   Explanation Code        918 - Member Liability The member is responsible for these out-of-pocket cost share amounts. 919 - Non-Billable Cost Share Do Not Bill Member; for this scenario the member is not liable for the cost share as the amount paid to the provider meets the contractual reimbursement. 920 - Bill Cost Share to Medicaid For this scenario, the associated cost share needs to be billed

Fidelis Care will host two Provider Office Hours in May 2024. During the webinar, Fidelis Care staff will be available to share information, explain different resources, and answer your questions. Provider Office Hours – May 2024 Topic: Back to Basics – Doing Business with Fidelis Care When:  Thursday, May 9th – 12PM – 1PM EST Click here to register*   Topic: Utilization Management When:  Thursday, May 23rd – 9AM – 10AM EST Click here to register* *Attendance will

Fidelis Care would like to inform providers about upcoming changes to our remittance advice.  Effective May 12, 2024, the Fidelis Care remittance advice will include Claim Adjustment Reason Codes (CARC) and Remittance Advice Remark Codes (RARC), along with a description of the codes.   CARCs describe why a claim or service line was paid differently than it was billed and RARCs provider additional explanation for an adjustment already described by a CARC or convey information about remittance advice.    There are two types of RARCs, supplemental and informational.  The majority of RARCs are supplemental; these are generally referred to as RARCs without further distinction.