Electronic Visit Verification (EVV) Authorization Guardrails

Dear Home Health Care providers,

Fidelis Care will implement billing guardrails within HHAeXchange to ensure continuity of service throughout the duration of an authorization period and enable visibility into changes of a member’s condition and/or home care needs. Currently, Fidelis Care sends Providers a courtesy of a reminder when it observes Providers scheduling over-authorizations.

This change is effective on March 17, 2025, and this communication serves as formal notice per the terms of the Agreement. 

Member Accommodation

• If there is a need to move a service by a day to accommodate a Member or to adjust due to an unavoidable staffing limitation, it is acceptable under some circumstances to move or adjust that day of service.
• A request to change or adjust is dependent upon the sound professional judgement of the provider. 
• The Fidelis Care provider quality and network departments will continue to monitor compliance with health plan guidelines and expectations. 

This change will better enable providers to accurately track utilization of authorized services and better enable Fidelis Care to quickly assess and respond to a Member’s needs. Fidelis Care will provide timely responses to issues or adjustments.

Included on the following page are examples of service schedule adjustments that Fidelis Care considers acceptable and reflects sound judgement. Providers are encouraged to ask additional questions and/or request a review of alternate examples directly with Fidelis Care via the HHAeXchange portal. Your feedback will be incorporated into updates to Frequently Asked Questions and other materials with the intent to benefit the Fidelis Care’s provider network.

Thank you for your continued partnership and commitment to delivering exceptional service to Fidelis Care members.