Find a Fidelis Care Community Office near you. Providers When we take care of each other, we tighten the bonds that connect and strengthen us all. Providers WebMedicaid Managed Care Medicaid Managed Care offers comprehensive coverage with no copays for covered services and no monthly premium for those who qualify. Search Members Login to your account, make a payment, see benefits and more. In-network providers will request any necessary prior authorization on your behalf. If you disagree with our decision about your medical bills, you have the right to appeal. We believe you are entitled to comprehensive medical care within the standards of good medical practice. Copayments or Coinsurance specified as not applicable toward the Deductible in the Benefit Summary. Disclaimer |Non-discrimination and Communication Assistance |Notice of Privacy Practice |Terms of Use & Privacy Policy, Providence Health Plan, 3601 SW Murray Blvd., Suite 10, Beaverton, Oregon 97005(if mailing, use only the post office box address listed above). The Fidelis Care 2023 Quality Care Incentives (QCI) Brochure has been updated to reflect a change to the member age range for two Diabetes Care measures. Payments for most Services are made directly to Providers. health With Provider Access Online, you can: View Patient Who can apply? Essential Plan Prior authorization is not a guarantee of coverage. 4.79. Part A is called hospital insurance. You'll qualify for Part A if you qualify for Social Security. You go to a hospital emergency room to have stitches removed, rather than wait for an appointment in your doctors office. If you have questions about any of the information listed below, please call customer service at 503-574-7500 or 800-878-4445.If any information listed below conflicts with your Contract, your Contract is the governing document. Claims adjustments. Fidelis Care Is Fidelis Medicare or Medicaid? An EOB explains how Providence processed your Claim, and will assist you in paying the appropriate member responsibility to your Provider. We encourage you to take advantage of this easy-to-use feature. Medicaid coverage must be recertified every 12 months. We reserve the right to deny payment for Services that are not Medically Necessary in accordance with our criteria. Sign in to Member Portal We're here to supply you with the support you need to provide for our members. Services that are not considered Medically Necessary will not be covered. For services that involve urgent medical conditions: Providence will notify your provider or you of its decision within 72 hours after the prior authorization request is received. Log in, register for an account, pay your bill, print ID cards, and more. WebEssential Plan Fidelis Care at Home (Managed Long Term Care) HealthierLife (Health and Recovery Plan) Medicaid Managed Care Medicare Advantage \ Dual Advantage (includes Flex) Medicaid Advantage Plus Metal-Level Products I am not a Fidelis Care member \ I dont know which Fidelis Care product I have (Search all) What are you looking for? Providence will complete its review and notify the requesting provider or you of its decision by the earlier of (a) 48 hours after the additional information is received or, (b) if no additional information is provided, 48 hours after the additional information was due. Is Fidelis Medicare or Medicaid? WebEvery year your state checks to see if you still qualify for Medicaid benefits. Selecting these links will take you away from KP.org. Please see your Benefit Summary for information about these Services. Health insurance will no longer be automatically renewed for Medicaid Managed Care, Essential Plan, Child Health Plus, or HealthierLife members. Medicaid If you qualify, Medicaid may be an option. The Prescription Drug Benefit provides coverage for prescription drugs which are Medically Necessary for the treatment of a covered illness or injury and which are dispensed by a Network Pharmacy pursuant to a prescription ordered by a Provider for use on an outpatient basis, subject to your Plans benefits, limitations, and exclusions. A portion of Medicare coverage, Part A, is free for most Americans who worked in the U.S. and paid in payroll taxes for many years. There are a variety of payment options, including, FIDELIS and FIDELIS CARE are trademarks of Centene Corporation, Transparency in Coverage Machine Readable Files, After logging in to the Member Portal, click the Make a Payment button. If you recently enrolled inChild Health Plus, the Essential Plan, or a Metal-Level Product,please select the button below to make your first payment. WebMedicaid Managed Care Medicaid Managed Care offers comprehensive coverage with no copays for covered services and no monthly premium for those who qualify. Because of recently passed federal legislation related to the end of the COVID-19 public health emergency, about nine million people in New York, including nearly 30,000 Guthrie patients and two million Fidelis Care members, will need to renew their health insurance for the first time in three years or risk losing coverage. About us Offer a medical therapeutic value at least equal to the Covered Service that would otherwise be performed or given. Choose the AutoPay Scheduling tab, select either the standard or the custom option, and follow the instructions to finish setting up AutoPay. While Guthrie has partnered with Fidelis in New York State to distribute this important message, this change also impacts our patients in Pennsylvania. Typically, Providence individual plans do not pay for Services performed by Out-of-Network Providers. Fidelis Care Login - WellCare During the second and third months of the grace period, your prescription drug coverage will be suspended and you will be required to pay 100 percent of the cost of your prescription drugs. Do I need to contact Medicare when I move? WebEnrollment for Fidelis Care at Home is year-round. Our medical directors and special committees of Network Providers determine which services are Medically Necessary. Prescription drugs must be purchased at one of our network pharmacies. Managed care plans are also referred to as Medicare Part C (Medicare Advantage) plans. This change could impact millions of New Yorkers with Medicaid, Child Health Plus, Essential Plan, and Managed Long Term Care coverage. Kaiser Permanente health plans around the country: Kaiser Foundation Health Plan, Inc., in Northern and Southern California and Hawaii Kaiser Foundation Health Plan of Colorado Kaiser Foundation Health Plan of Georgia, Inc., Nine Piedmont Center, 3495 Piedmont Road NE, Atlanta, GA 30305, 404-364-7000 Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc., in Maryland, Virginia, and Washington, D.C., 2101 E. Jefferson St., Rockville, MD 20852 Kaiser Foundation Health Plan of the Northwest, 500 NE Multnomah St., Suite 100, Portland, OR 97232 Kaiser Foundation Health Plan of Washington or Kaiser Foundation Health Plan of Washington Options, Inc.,1300 SW 27thSt., Renton, WA 98057. If you or your provider fail to obtain a prior authorization when it is required, any claims for the services that require prior authorization may be denied. To obtain prescriptions by mail, your physician or Provider can call in or electronically send the prescription, or you can mail your prescription along with your Providence Member ID number to one of our Network mail-order Pharmacies. The member age range of 18-75 also applies to HbA1c Poor Control. Prior authorization of claims for medical conditions not considered urgent. Learn more about Medicaid renewal. To qualify for Medicaid, you must meet certain state-specific requirements. To qualify for expedited review, the request must be based upon exigent circumstances. The following costs do not apply towards your Deductible: The Oregon Health Insurance Marketplace, where people can shop for plans and receive tax credits, including Advance Premium Tax Credits, to help pay for their Premiums and Covered Services. Provided to you while you are a Member and eligible for the Service under your Contract. We reserve the right to make substitutions for Covered Services; these substituted Services must: * If you fail to obtain a Prior Authorization when it is required, any claims for the services that require Prior Authorization may be denied. Providence Health Plan offers commercial group, individual health coverage and ASO services.Providence Health Assurance is an HMO, HMOPOS and HMO SNP with Medicare and Oregon Health Plan contracts. Payment is based on eligibility and benefits at the time of service. Setting it up is easy: After logging in to the Member Portal, click the Make a Payment button Select the name of your plan Making a partial Premium payment is considered a failure to pay the Premium. Your Plan only pays for Covered Services received from approved, Prior Authorized Out-of-Network Providers at rates allowed under your plan. Live-agent chat is the easiest and fastest way to get real-time support for an array of topics, including: You can even print your chat history to reference later! Make A Payment You can find in-network Providers using the Providence Provider search tool. If you are seeking services from an out-of-network provider or facility at contracted rates, a prior authorization is required. Payment will be made to the Policyholder or, if deceased, to the Policyholders estate, unless payment to other parties is authorized in writing. The Plan does not have a contract with all providers or facilities. Medicaid Managed Care What kind of insurance is Fidelis? If you do not pay the Premium within 10 days after the due date, we will mail you a Notice of Delinquency. Pay your premium online usingyour Member ID. Providence will then notify you of its reconsideration decision within 24 hours after your request is received. If we do not send you the Premium delinquency notice specified above, we will continue the Contract in effect, without payment of Premium, until we provide such notice. A request for payment that you or your health care Provider submits to Providence when you get drugs, medical devices, or receive Covered Services. No copays for covered services and no monthly premium if qualified. Navigation Menu - Opens a Simulated Dialog, Learn about Your Medicaid/Medi-Cal Options, Request for confidential communications forms, Learn more about link terms and conditions. Part C offers an alternate way to receive your Medicare benefits (see below for more information). Fidelis Care is a New York-based health insurance company formed in 1993. WebMedicaid Managed Care Medicaid Managed Care offers comprehensive coverage with no copays for covered services and no monthly premium for those who qualify. Log in, register for an account, pay your bill, print ID cards, and more. Fidelis Insurance Register. If your premium is not received by the last day of the month, you will enter a grace period which begins retroactively on the first of the month. This process is called Medicaid renewal, redetermination, or recertification. Medicaid If you pay your Premiums in full before the date specified in the notice of delinquency, your coverage will remain in force and Providence will pay all eligible Pended Claims according to the terms of your coverage. Web, Get Ready to Renew Automatic renewals will end soon, and you will need to take action to renew your health insurance. Children and adults who meet income, resource, age, and/or disability requirements can apply for Medicaid. If you choose a brand-name drug when a generic-equivalent is available, any difference in cost for Prescription Drug Covered Services will not apply to your Calendar Year Deductibles and Out-of-Pocket Maximums. Effective April 1, 2023, all Fidelis Care members enrolled in Medicaid Managed Care and HealthierLife (HARP) will receive their prescription drugs through NYRx, the Medicaid Pharmacy Program. The following information is provided to help you access care under your health insurance plan. Enrollment in Providence Health Assurance depends on contract renewal. Can I change Medicare Supplement plans anytime? During the first month of the grace period, your prescription drug claims will be covered according to your prescription drug benefits. The website www.cms.gov has information on both Medicare and Medicaid. 4.79. Log into your account, view patient information, and more. Benefits. Web2023 Wellcare Fidelis Assist and Wellcare Fidelis No Premium Medicare Members: As part of your plan, you have access to a Preferred Pharmacy Network with lower costs. You can find your Contract here. When you get emergency care or get treated by an Out-of-Network Provider at an in-network hospital or ambulatory surgical center, you are protected from surprise billing or balance billing. Members will be responsible for applicable Copayments, Coinsurances, and Deductibles. Dr. Kibot is a board-certified family nurse practitioner who has been practicing since 2016. Created in 1965, Medicaid is a public insurance program that provides health coverage to low-income families and individuals, including children, parents, pregnant women, seniors, and people with disabilities; it is funded jointly by the federal government and the states. A list of drugs covered by Providence specific to your health insurance plan. Effective April 1, 2023, all Fidelis Care members enrolled in Medicaid Managed Care and HealthierLife (HARP) will receive their prescription drugs through NYRx, the Medicaid Pharmacy Program. Search Members Login to your account, make a payment, see benefits and more. Fidelis Care How does a professional indemnity claim work? If you have questions about any of the information listed below, please call customer service at 503-574-7500 or 800-878-4445. Submit a request for access Need an Account? If we need additional time to process your Claim, we will explain the reason in a notice of delay that we will send you within 30 days after receiving your Claim. Sign in to Member Portal If we need additional information to complete the processing of your Claim, the notice of delay will state the additional information needed, and you (or your provider) will have 45 days to submit the additional information. All hospital and birthing center admissions for maternity/delivery services, Inpatient rehabilitation facility admissions, Inpatient mental health and/or chemical dependency services, Procedures, surgeries, treatments which may be considered investigational. Managed care plans take the place of original Medicare. To facilitate our review of the Prior Authorization request, we may require additional information about the Members condition and/or the Service requested. FIDELIS and FIDELIS CARE are trademarks of Centene Corporation, Important Updates Regarding Coronavirus COVID-19, Transparency in Coverage Machine Readable Files, You have or are eligible for New York State Medicaid, You have been assessed by a nurse as eligible for the required level of care, Home health care, including nursing, physical therapy, and/or occupational therapy, Personal care (assistance with daily living tasks). However, Claims for the second and third month of the grace period are pended. If you have a Marketplace plan and receive a tax credit that helps you pay your Premium (Advance Premium Tax Credit), and do not pay your Premium within 10 days of the due date in any given month, you will be sent a Notice of Delinquency. WebLive-agent chat is the easiest and fastest way to get real-time support for an array of topics, including: Member Eligibility. Enrollment in Fidelis Care depends on contract renewal. If your appeal involves (a) medically necessary treatment, (b) experimental investigational treatment, (c) an active course of treatment for purposes of continuity of care, (d) whether a course of treatment is delivered in an appropriate setting at an appropriate level of care, or (e) an exception to a prescription drug formulary, you may waive your right to internal appeal and request an external review by an Independent Review Organization. Prior authorization for services that involve urgent medical conditions. No copays for covered services and no monthly premium if qualified. If Providence finds a problem with a Claim (such as a duplicate or improperly coded Claim) after the Claim has been paid, Providence can retroactively deny the Claim to fix the problem. Essential Plan Our right of recovery applies to any excess benefit, including, but not limited to, benefits obtained through fraud, error, or duplicate coverage relating to any Member. Under no circumstances (with the exception of Emergency and Urgent Care) will we cover Services received from an Out-of-Network Provider/Facility unless we have Prior Authorized the Out-of-Network Provider/Facility and the Services received.