1. Media Fall Seminar
November 10, 2016

2. Product Portfolio Medicaid Managed Care Child Health Plus
Essential Plan
Healthier Life – Health and Recovery Plan (HARP)
Fidelis Care at Home – Managed Long Term Care (MLTC)
Metal-Level Products
Medicaid Advantage Plus (Special Needs Program)
Fidelis Medicare Advantage Products
Fidelis Dual Advantage Products (Special Needs Program)

3. Provider Resources • fideliscare.org – Provider Tab • Provider Manual
• Authorization Grid
• Pharmacy Services
• Provider Access Online
• Provider Resources
– Tip Sheets

4. Authorization Grid Updates
Please refer to fideliscare.org for the latest authorization grids.
Recent Updates:
September 1, 2016
Revenue Codes 944/945 no longer require an authorization
August 1, 2016
Outpatient Surgery codes:  31295, 31296, added
Outpatient Surgery - Gender reassignment surgery codes:  55970, added to Essential Plan, NY State of Health

5. Provider Manual: Claims Section
• Claims Submission
– 90-Day Timely Filing Period
• Billing Guidelines
– Suggestions to Expedite Claims Processing
– Well Care and Sick Visits
– Locum Tenens

6. Claims Continued • Forms • Appeals – Affidavit Form
– Corrected Claim Form
• Appeals
– Standard Appeals
• 60 Business Days from Denial Date
• Provider Appeals Form
– External Appeals
• Four months from the receipt of the Final Adverse Determination

7. Checking Authorization Status Online
Fidelis Care now offers providers the ability to check authorization status online, any time of the day or night. This new tool allows you to retrieve information about your previously submitted authorizations with no hold or wait time! 
To get started:
Provider account administrators will need to log in to Provider Access Online and assign the new role, “Authorization Viewer”, to account users who need access to view authorizations. 
For complete authorization details and user guide, providers can visit Provider Access Online at fideliscare.org.

8. Interactive Voice Response
Fidelis Care’s new automated service allows providers to check claim status over the phone, any time of the day or night.
Call FIDELIS ( ) and follow the prompts. You can obtain basic claim information, such as the paid amount and member responsibility. For complete claim details, log in to Provider Access Online at fideliscare.org.
Claim Details Available on IVR
Fidelis Care Claim Number
Received Date
Total Amount Billed
Date the Claim Was Complete
Allowed Amount
Disallowed Amount
Member Responsibility

9. Demographic Updates
Please be sure to notify Provider Relations of any demographic updates. • Address/Phone/Fax Changes • Open/Closed Panels • Provider Updates

10. Help for Uninsured Patients
Fidelis Care Representatives:
Offer all available Managed Care plans to all potential candidates
Make the enrollment process as easy as possible
Can assist with renewal
Meet applicants at work, home, school, provider office, or convenient locations in the community
Are available after hours and on weekends

11. Fax Referral Process Personalized fax referral form
Uninsured/renewing patient completes; provider office faxes to number on form
Referral assigned to a Representative who will attempt to contact individual by phone or mail
If eligible, Representative will set up appointment at convenient location
All referrals are tracked, enrollment rates are measured, and reported back to the provider

12. Important Phone Numbers
Name
Phone Number
Provider Service Unit
(Option 1, then Option 2, then Option 4)
Medical Authorizations
(Option 1, then Option 2, then Option 2)
Behavioral Health Authorizations
(Option 1, then Option 2, then Option 3)
DentaQuest
Davis Vision
Caremark Pharmacy
Daniel Lloyd
Supervisor, Provider Relations
(315)