Fidelis SecureCare of North Carolina Provider Manual

More documents

Recommendations

Info

Appealing a Claims Payment or Denial (Note: This process should not be used for appealing services that were denied) Providers needing adjustments on claims that were previously paid or denied in error may contact the Fidelis Customer Service Department at 1-877-372-8085 or; submit a copy of the claim along with a written request containing the following: • Provider name, provider ID number and provider billing address • Claim number of original claim (from provider remittance advice). • Member name • Member ID number • Date(s) of service • Indicate telephone number and name of contact person in your office if we have questions or need additional information Claims Information Online The Fidelis provider portal now allows you to access member eligibility and claims information online, 24 hours a day, seven days a week. Logging In To access the provider portal, go to the Fidelis Secure Care website and click in the link for the Provider Portal. http://www.fidelissc.com/home/index.asp Once you reach the provider portal, you will see the Log In Screen: You can receive your username and password with the help of the Fidelis staff, or by clicking the link under the “Not registered for the provider portal” section. Billing and Payment
Claims Look-Up Once logged in, you may select from the menu of options at the top of the screen. The Essence of Care Member Eligibility' Lookup Claims Lookup Your Account Logout Using the options below,you can search claims information by: Status and Date Range, Claim ID, Subscriber ID, Or an exact match on First Name, Last Name, and Date of Birth Claims LookU>Iby Subscriber ID or·Nmne andDate of Birtll Claims Lookup by Claim10 or St
Page 1 and 2: Provider Manual North Carolina
Page 3 and 4: Utilization Management Affirmative
Page 5 and 6: Fraud, Waste and Abuse Provider and
Page 7 and 8: Regulations and Responsibilities Co
Page 9 and 10: • Contracted providers agree to r
Page 11 and 12: Physician Responsibilities Primary
Page 13 and 14: Access to Care Fidelis has adopted
Page 15 and 16: The Care Management team is compris
Page 17 and 18: • Psychotropic Medication Managem
Page 19 and 20: Credentialing Credentialing Program
Page 21 and 22: SecureCare members only as a result
Page 23 and 24: • Have no significant utilization
Page 25 and 26: Medical/treatment record keeping re
Page 27 and 28: Eligibility You may verify the elig
Page 29 and 30: You can receive your username and p
Page 31 and 32: Quality Program Purpose The purpose
Page 33 and 34: Referral and Prior Authorization Pr
Page 35 and 36: Referrals to Non-Participating Prov
Page 37 and 38: Criteria for Authorizing Part A Ski
Page 39 and 40: Fidelis SecureCare Criteria for Aut
Page 41 and 42: OUTPATIENT CARE COORDINATION PHONE:
Page 43: Remittance Advice (RA) Payments rec
Page 47 and 48: Claim Disputes and Appeals Appealin
Page 49 and 50: Fidelis will reimburse the facility

Fidelis SecureCare of North Carolina Provider Manual

Create successful ePaper yourself

Delete template?

Save as template?