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The following sections of the Fidelis Care authorization grids have been updated effective June 1, 2024.   The following codes have been added on the Medicaid, Medicare, Essential Plan, and Metal-Level Products Authorization Grids and require prior authorization: J0209    sodium thiosulfate (Hope) J1434    fosaprepitant (Focinvez)   The following codes have been added to the Medicaid DME Authorization Grid and require prior authorization: E0468     Home ventilator, dual-function respiratory device, also performs additional function of cough stimulation, includes all accessories, components and supplies for all functions E2298     Complex rehabilitative power wheelchair accessory, power seat elevation system, any type K1037     Docking station for use with oral device/appliance used to reduce

Fidelis Care will host two Provider Office Hours in April 2024. During the webinar, Fidelis Care staff will be available to share information, explain different resources, and answer your questions. Provider Office Hours – April 2024 Topic: Back to Basics – Doing Business with Fidelis Care When:  Thursday, April 18th – 9AM – 10AM EST Click here to register*   Topic: Provider Portal – Claim and Authorization Appeals When:  Thursday, April 25th - 3PM - 4PM EST Click here to

The Fidelis Care Provider Relations Department is committed to building strong and lasting relationships with our providers and their staff.  To foster this partnership, we have assigned a Provider Relations Specialist to communicate important information and provide support to our providers. Please be sure to reference our Contact Your Designated Provider Relations Specialist web page if you do not know the name of the specialist assigned to your provider group.  To note, there are times that we adjust territory assignments to better serve our providers, so it important to periodically verify your assigned specialist. If you are unable to determine the identity

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: 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. Select Authorization Status located on the menu on the left side of the page. On the Authorization Search page, click on Search All Authorizations. You can search by Subscriber ID, Authorization

Fidelis Care would like to share important information pertaining to claim submissions for the new Essential Plan 200-250 plan.     A significant number of members who are now covered under the new Essential Plan 200-250, previously had coverage under an Ambetter from Fidelis Care marketplace plan.  In many cases, the transition to the Essential plan created new subscriber IDs.    In order to support timely and accurate claims processing, please be sure that claims with dates of service 4/1/2024 and later are submitted under the member’s most current Essential Plan member ID.  Any claims for dates of service prior to 4/1/2024 must be