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Starting January 1, 2025, Fidelis Care will provide outpatient behavioral health benefits to NJ FamilyCare members. Learn more about the behavioral health benefit changes (PDF).

Coordination of Benefits Review

August 1, 2024

Dear Provider,

Thank you for your continued partnership with Fidelis Care. As you know, we are committed to continuously evaluating and improving overall Payment Integrity solutions as required by State and Federal governing entities. We are writing today to inform you of an additional review that will go into place on or after 8/1/2024.

Description of Changes

 

Lines of Business

Wellcare claims will be reviewed for coordination of benefits by Rawlings, an external vendor. In accordance to policy CC.PI.09 (Coordination of Benefits/Third Party Liability/Subrogation), providers will begin seeing correspondence from Rawlings when these claims are identified as being incorrectly paid for members with other primary coverage. Instructions for next steps and how to outreach for additional information will be included in the letters that Rawlings will send to the providers.

Medicare

 

Thank you for your continued participation and cooperation in our ongoing efforts to render quality health care to our members. We look forward to helping you provide the highest quality of care for our members.

Sincerely,

Fidelis Care