Fidelis SecureCare of North Carolina Provider Manual

• Have no significant utilization issues and member services issues or complaints
identified and documented by Fidelis during participation period.
• Agrees to follow Fidelis policies and procedures.
Provider Rights
As a network provider, you have the right to:
• Review information submitted to your credentialing application.
• Correct erroneous information collected during the credentialing process.
• Be informed of the status of your credentialing or re-credentialing application.
• Be notified of these rights.
Requests for Additional Information
If Fidelis receives information from an outside source that differs substantially from
information you have provided us, we will contact you directly as soon as the
discrepancy is noted and request your clarification in writing within 10 business days.
Appeals Process for Providers Terminated or Rejected from the Fidelis Provider
Network
A provider has the right to appeal a Quality and Peer Review Committee decision that
has negatively impacted the provider. Fidelis complies with all state and federal
mandates with respect to appeals for providers terminated or rejected from the Fidelis
provider network. Fidelis notifies the provider in writing of the reason for the denial,
suspension and termination. Terminated or rejected providers may submit a request for
an appeal as outlined in the letter of rejection/termination sent by Fidelis. In addition, the
request for appeal must be received by Fidelis within ten (10) days of the date of the
rejection/termination letter. Upon receipt of the letter by Fidelis, the appeal is forwarded
to the Fidelis Appeals Committee for review and further processing Fidelis will ensure
that the majority of the hearing panel members are peers of the affected physician.