Fidelis Care at a glance
| Legal name | Fidelis Care New York |
|---|---|
| Also known as | Fidelis, Fidelis Care NY |
| Category | Medicaid MCO |
| Parent organization | Centene Corporation |
| Claims payer ID | Fidelis identifies Availity as its preferred claims clearinghouse and also supports Inovalon and other clearinghouses. Confirm forwarding and the member product with the selected clearinghouse; Fidelis and Wellcare inquiry routes differ. |
| Eligibility (270/271) payer ID | 11315 — registry reference; verify the member product, transaction and clearinghouse |
| ERA (835) payer ID | 11315 — registry reference; verify the member product, transaction and clearinghouse |
| NAIC company code | Not established in this registry |
| States covered | New York |
| Members covered | ~2.4 million members |
| Provider resource entry point | https://www.fideliscare.org/Provider |
| Provider phone | 1-888-343-3547 |
Always verify claims-routing details against the member ID card and the payer's current EDI companion guide before submission.
Timely filing & appeals for Fidelis Care
This registry lists 90 days as an initial-claim reference for Fidelis Care. Confirm the applicable product, provider agreement, start event and current payer instructions. Do not apply this value automatically to out-of-network, secondary, corrected or appealed claims.
| Submission type | Window |
|---|---|
| Initial claim reference | 90 days (verify applicability) |
| Out-of-network initial claim | Verify the member's plan and applicable out-of-network rules |
| Secondary / coordination of benefits | Verify the allowed window and start event; a primary EOB does not automatically restart filing |
| Corrected claim | Verify correction instructions; do not substitute an appeal deadline |
| Reconsideration / appeal | Use the applicable denial or decision notice and the process below |
This registry has not established a payer-specific appeal ladder for Fidelis Care. Use the denial notice, plan document, provider agreement, or jurisdictional rule to assign the correct route and deadline. Missing registry evidence does not mean appeal rights are unavailable.
Source: Fidelis Care provider policy. Always confirm before disputing a TFL denial — payer policies are versioned and product-specific.
Prior authorization with Fidelis Care
Decision deadlines depend on the product, service and urgency. CMS-0057-F generally starts its decision-timeframe requirements in 2026 for Medicare Advantage, Medicaid and CHIP payers subject to the rule: seven calendar days for standard requests and 72 hours for expedited requests. Those requirements exclude drug authorizations and QHP issuers on the federally facilitated exchanges. Other plans, state rules and permitted extensions can differ. Check the applicable policy; a decision deadline is not a guarantee of approval.
CMS-0057-F decision-timeframe requirements and exclusions
Verify Fidelis Care electronic claims (837), eligibility (270/271), remittance (835) and authorization (278) separately for the member product and clearinghouse. Registry flags and routing references are not current transaction-complete approval. Confirm the companion guide, enrollment and applicable source findings below. A blank or unverified field does not establish that the transaction is unavailable. Authorization requirements and submission channels depend on the product, service and delegated reviewer. Verify the applicable policy before scheduling; a portal listing is not proof of X12 278 connectivity.
This registry does not provide a current prior-authorization code list for Fidelis Care. Start with the provider resources or the policy documents below, then confirm the applicable product, service and effective date. A resource link does not establish that a live code-lookup tool is available.
Top denial reasons for Fidelis Care
Per-payer denial benchmarks publish here once the QuickIntell anonymized ETL pipeline ingests sufficient Fidelis Care volume. Until then, see the broader CARC reference for industry-wide remediation guides.
Electronic claims, eligibility & ERA
| Transaction | Registry indication — not verification | Routing reference |
|---|---|---|
| 837P / 837I claims | Listed in registry; verify current scope | Fidelis identifies Availity as its preferred claims clearinghouse and also supports Inovalon and other clearinghouses. Confirm forwarding and the member product with the selected clearinghouse; Fidelis and Wellcare inquiry routes differ. |
| 270 / 271 eligibility | Listed in registry; verify current scope | 11315 — registry reference; verify the member product, transaction and clearinghouse |
| 278 prior authorization | Listed in registry; verify current scope | Verify X12 278 routing separately |
| 835 ERA | Verify support and enrollment separately | 11315 — registry reference; verify the member product, transaction and clearinghouse |
Payer IDs vary by clearinghouse — confirm against your clearinghouse payer list (Availity, Change Healthcare/Optum, Waystar) before configuring submitter routing.
Source checks and remaining limits
The latest partial comparison is dated . Retained earlier findings keep their original dates below. This is a partial source check, not a whole-page, clinical or legal review. It does not refresh the legacy review date above.
portal_url
Source comparison: 2026-09-26
The current provider assistance page links Provider Access Online and directs providers to current plan resources.
Primary source for portal_urlpayer_ids.claims
Source comparison: 2026-09-26
Current EDI page supports Availity/Inovalon/other-clearinghouse submission with routing confirmation, but does not itself state 11315. Leave the scalar unverified; distinguish Fidelis and Wellcare products.
Primary source for payer_ids.claimspayer_ids.eligibility / payer_ids.era / era_payer_id
Source comparison: 2026-09-26
The EDI page directs 835ERA enrollment to the clearinghouse and links transaction-specific companion guides. No individual eligibility/ERA identifier was verified.
Primary source for payer_ids.eligibility / payer_ids.era / era_payer_id
Not checked in this pass: Whole-record approval, legal identity, ownership and complete product coverage; Authenticated transactions and QuickIntell integrations; timely_filing_days: Search finds older 2018-2023 product documents with 90 days/contract language, but no current scoped filing rule was directly confirmed. Do not renew the blanket 90-day claim.; record_scope: Not verified by the retrieved sources in this bounded comparison; retain explicit uncertainty and do not infer from another field or organization.; provider_phone: Not verified by the retrieved sources in this bounded comparison; retain explicit uncertainty and do not infer from another field or organization.; electronic_claims_supported / supports_279_271 / supports_278: Not verified by the retrieved sources in this bounded comparison; retain explicit uncertainty and do not infer from another field or organization.; appeal_levels / prior_auth_required_codes_sample / qi_module_coverage: Not verified by the retrieved sources in this bounded comparison; retain explicit uncertainty and do not infer from another field or organization..
Sources used for this guide
State coverage
Fidelis Care operates in the following states. Each link opens state-level Medicaid program details, dominant commercial payers, and state-specific RCM regulations.
Evaluate QuickIntell workflow fit for Fidelis Care
These module references are evaluation starting points, not evidence of a validated connection, supported transaction or customer deployment. Confirm the actual member plan, data access and product scope first.
- QuickRCM
Evaluate claim preparation, follow-up and denial worklists for Fidelis Care; verify the actual plan rules and available connections before implementation.
- QuickAuth
Assess authorization-packet and status workflows for Fidelis Care; confirm product, service, delegated reviewer and permitted submission channels.
- QuickERA
Verify the actual 835 files, posting exceptions and reconciliation requirements for Fidelis Care before evaluating automation. An ERA identifier alone does not establish supported ingestion or posting.
Frequently asked questions about Fidelis Care
Where is the Fidelis Care provider portal?
Use https://www.fideliscare.org/Provider as a starting point for Fidelis Care provider resources. This link may open a directory or contact page rather than a transaction portal. Select the applicable product and administrator, then verify the available functions, enrollment and access requirements. QuickIntell is not the official payer portal.
What is the timely filing limit for Fidelis Care?
This registry lists 90 days as an initial-claim reference for Fidelis Care. Confirm the applicable product, provider agreement, start event and current payer instructions. Do not apply this value automatically to out-of-network, secondary, corrected or appealed claims.
What is the Fidelis Care payer ID?
Claims: Fidelis identifies Availity as its preferred claims clearinghouse and also supports Inovalon and other clearinghouses. Confirm forwarding and the member product with the selected clearinghouse; Fidelis and Wellcare inquiry routes differ.. Eligibility (270/271): 11315 — registry reference; verify the member product, transaction and clearinghouse. ERA (835): 11315 — registry reference; verify the member product, transaction and clearinghouse. Do not substitute a claims ID for an unverified transaction ID. Check current source findings and the member ID card before submitting.
Does Fidelis Care accept electronic claims?
Verify Fidelis Care electronic claims (837), eligibility (270/271), remittance (835) and authorization (278) separately for the member product and clearinghouse. Registry flags and routing references are not current transaction-complete approval. Confirm the companion guide, enrollment and applicable source findings below. A blank or unverified field does not establish that the transaction is unavailable.
How do I appeal a Fidelis Care denial?
This registry has not established a payer-specific appeal ladder for Fidelis Care. Use the denial notice, plan document, provider agreement, or jurisdictional rule to assign the correct route and deadline. Missing registry evidence does not mean appeal rights are unavailable.
How long do Fidelis Care prior authorization approvals take?
Decision deadlines depend on the product, service and urgency. CMS-0057-F generally starts its decision-timeframe requirements in 2026 for Medicare Advantage, Medicaid and CHIP payers subject to the rule: seven calendar days for standard requests and 72 hours for expedited requests. Those requirements exclude drug authorizations and QHP issuers on the federally facilitated exchanges. Other plans, state rules and permitted extensions can differ. Check the applicable policy; a decision deadline is not a guarantee of approval.
What is the Fidelis Care provider phone number?
This registry lists 1-888-343-3547 as a contact reference for Fidelis Care. Confirm the number and service scope against the member ID card and current product-specific directory; claims, eligibility and authorization inquiries may use different teams.
Automate workflows around Fidelis Care requirements
Connect eligibility, prior authorization, pre-submission claim checks, and remittance routing in one governed workflow. Payer and plan configuration is confirmed during implementation.
Disclaimer
This page is operational reference for medical-billing professionals. It is not legal, clinical, or contractual advice. Payer policies change without notice — always verify against Fidelis Care's current published documents before submission. CPT® is a registered trademark of the American Medical Association.