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Effective August 17th, 2026, Pre- and Post-Decision Peer-to-Peer (P2P) discussions will no longer result in reconsideration of inpatient and post-acute care authorization determinations. Any reconsideration of an adverse coverage determination will instead be managed exclusively through the formal appeals process. The Wellcare Model of Care includes a standard provision stating that “provider peer-to-peer requests are permitted for disagreement with UM clinical decision making.” This language does not supersede Medicare UM or appeal requirements; any P2P process is limited to clarification of clinical rationale rather than decision-making or reconsideration of the determination. This operational change to the utilization management (UM) process is effective

Fidelis Care would like to remind providers of the importance of using the appropriate submission process when requesting an expedited authorization review. Our provider portal is designed to support standard authorization requests only. At times, authorization requests submitted through the portal include clinical documentation indicating the request should be reviewed on an expedited basis. Because expedited requests require a different review pathway and turnaround time, submitting these requests through the standard portal workflow may result in delays and can impact timely processing. If a request meets criteria for expedited review, please follow the expedited authorization submission process outlined in the Provider

To better protect information and meet state requirements, we’re adding an extra layer of security when you log in to the secure Wellcare and Fidelis Care provider portals. We know logging in is part of your daily workflow, and this update is designed to add security while keeping the process simple and familiar.   What to expect Starting soon, you will be asked to use multi-factor authentication (MFA) when logging in to the provider portal. After entering your username and password, you’ll confirm your login with a one-time code sent via SMS to your phone. Once you’re signed in, everything in the

As you may be aware, Section 12006 of the 21st Century Cures Act, along with CMS guidance, required states to implement Electronic Visit Verification (EVV) for Personal Care Services by January 1, 2021, and for Home Health Care Services by January 1, 2023. As of 2026, EVV requirements are fully implemented, requiring applicable services to be electronically verified and documented, including the member receiving care, caregiver, service location, date, and type of service provided.   Next Steps To ensure EVV data is accurately captured for providers delivering in-scope EVV services, Fidelis Care will require all providers — including existing EDI and Enterprise (ENT) providers — to submit

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 Engagement Account Manager. To identify your designated representative, please