Payment Policy
This notice is to clarify a segment of Fidelis Care's payment policy language applicable to all Fidelis Care Medicaid markets. Fidelis Care's payment policies are based on publicly distributed guidelines from established industry sources such as the Centers for Medicare and Medicaid Services (CMS), the American Medical Association (AMA), state health care agencies and medical specialty professional societies.
If you have questions about this information, please contact your Provider Relations representative.
- 3-Day Payment Policy: CC.PP.500 (PDF)
- Appropriate Place of Service (POS) Billing (PDF)
- Clean Claim Reviews: CC.PI.04 (PDF)
- Comprehensive Payment Integrity: CPP-136 (PDF)
- Cost to Charge Adjustments on Clean Claim Reviews: CC.PI.06 (PDF)
- E/M Overcoding Policy: CPP-110 (PDF)
- Emergency Department Facility Coding: CPP-105 (PDF)
- Emergency Department Radiology Utilization: CPP-106 (PDF)
- Gastrointestinal Pathogen Nucleic Acid Detection Panel Testing: CP.MP.209 (PDF)
- Inpatient Hospital Short Stays: CPP-147 (PDF)
- Inpatient Readmission: CPP-123 (PDF)
- Intensity Modulated Radiation Therapy (IMRT): CPP-108 (PDF)
- Maximum Units for Reimbursement Policy: CPP-111 (PDF)
- Pre-Pay Code and Modifier Validation: CPP-152 (PDF)
- Pre-Payment and Post-Payment Review: CPP-102 (PDF)
- Procedure to Procedure Associated Modifiers: CPP-127 (PDF)
- Renal Dialysis: CPP-114 (PDF)
- Review of NOS, NEC, and Unlisted Codes: CPP-107 (PDF)
- Robotic Assisted Surgery: CPP-137 (PDF)
- Sepsis Diagnosis: CC.PP.073 (PDF)
- Ultrasound in Pregnancy CP.MP.38 (PDF)
- Unbundling Adjustments on Clean Claim Reviews: CC.PI.10 (PDF)