What is the process for filing a claim for services covered by Fidelis Care?

Filing a claim for services covered by Fidelis Care typically involves a systematic process, designed to ensure that members receive the benefits they are entitled to. First, it is essential to understand that healthcare providers usually file claims on behalf of their patients. When a member receives services from an in-network provider, the provider will submit the claim directly to Fidelis Care after the service has been rendered. This process helps streamline the claims management and reduces the administrative burden for the member. However, if a member needs to file a claim for services provided by an out-of-network provider, the individual must take the steps necessary to submit the claim independently. To do this, it is important to gather all related documentation, including itemized bills and any receipts for services received. Additionally, members should ensure they have their member identification number and any relevant details about the services received. Once all documentation is prepared, the claim can be submitted to Fidelis Care through the appropriate channel, typically via mail or online, if applicable. Members should check the specific fax number or mailing address for claims on the official Fidelis Care website or their member portal. After the claim is submitted, it will be reviewed by Fidelis Care to determine coverage eligibility and the amount eligible for reimbursement. It may take some time for processing, and members will receive a notification regarding the claim's status. For the most current information regarding claims filing, including forms and specific address details, it is advisable to review the resources available on the Fidelis Care website.