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Fidelis Care would like to remind providers to respond to a recent email sent to all behavioral health providers regarding a program evaluation and survey.  The purpose of this evaluation is to improve our members’ experience in obtaining access to Behavioral Healthcare.   Fidelis Care is committed to promoting health equity and ensuring access to behavioral healthcare for all our members. We recognize that for many people, knowing the race, ethnicity, and gender identity of their prospective clinician may help them initially engage and build a strong relationship with the clinician. We are also seeking to learn the clinical specialties offered by

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