Fidelis Timely Filing Limit 2026: 90 Days in New York, 180 in New Jersey, 60 for Corrected Claims

Fidelis Care does not have one timely filing limit. Fidelis Care New York requires initial claims within 90 calendar days of the date of service across Medicaid, Child Health Plus, Essential Plan, Ambetter, and Wellcare By Fidelis Care Medicare. Corrected claims are due within 60 calendar days of the remittance date.

Fidelis Care is a Centene Corporation subsidiary and New York Medicaid managed care organization covering roughly 2.4 million members, submitting claims under payer ID 11315. Fidelis Care New Jersey operates as a separate company with its own filing rules.

That second sentence is where the confusion starts. Search the deadline and you'll find 90 days on one page and 180 days on another. Both numbers are accurate. They're describing different states.

Here's what the mix-up costs. A biller working a Wellcare By Fidelis Care dual claim applies a figure they found online, misses by three weeks, and a payable balance turns into a write-off nobody planned for.

The number you need depends on three things: the state, the line of business, and what you're actually submitting. An initial claim, a corrected claim, and an appeal each run on a separate clock with a separate trigger date.

Every deadline below is traced to a named Fidelis Care document with its version and effective date, so you can check the figure against the source it came from.

Fidelis Timely Filing Limits at a Glance

The table below carries every published Fidelis Care filing deadline with its controlling document. Where a figure could not be confirmed against a Fidelis primary source, it is labeled rather than presented as settled.

Why There Is No Single Fidelis Timely Filing Limit

Fidelis Care New York and Fidelis Care New Jersey Are Different Payers

Fidelis Care New York and Fidelis Care New Jersey publish different timely filing rules. New York lines of business use 90 calendar days from the date of service. Fidelis Care New Jersey MLTSS uses 180 days or 6 months, measured from the Medicaid or primary insurance payment date, whichever is later, per the Fidelis Care New Jersey MLTSS claims page.

Two domains, two rule sets. New York providers work from fideliscare.org. New Jersey providers work from fideliscarenj.com. Search engines blend the two constantly, which is why a New York biller often lands on a New Jersey page without noticing.

That's the source of the 180-day figure floating around. It's a real number from a real Fidelis document, and it does not apply to a New York claim. If you bill both states, the Fidelis Care New Jersey enrollment requirements sit on a different track too.

New Jersey MLTSS also treats initial, corrected, and voided claims under the same 180-day window, unless the Participation Agreement says otherwise. New York splits those into separate windows. Applying one state's structure to the other breaks in both directions.

Your Provider Agreement Overrides the Published Number

Fidelis Care states that claims and appeals must be submitted within the timeframes specified by the provider contract. The published 90-day figure is the standard, not the ceiling. Confirm your own window against the Fidelis Care provider manuals and your signed agreement.

This one catches experienced practices. A group bills Fidelis for six years on a 90-day assumption, never opens the contract, and then discovers a negotiated term that was different the whole time. Sometimes it's longer. Sometimes it's shorter.

The fix takes 20 minutes. Pull the Participation Agreement, find the claims submission article, and write the number down next to each plan name you're contracted for. Then treat that sheet as the source of truth, not a search result.

Fidelis Timely Filing Limit by Plan and Line of Business

Fidelis Care runs five distinct lines of business, and the filing rules are not identical across them. The matrix below separates each one by initial claim, corrected claim, and appeal window.

Fidelis Care New York Medicaid and Child Health Plus

Fidelis Care requires Medicaid and Child Health Plus claims within 90 calendar days of the date of service, per the V26.0 provider tip sheets effective January 1, 2026. HARP members fall under the Medicaid line and follow the same 90-day window.

One thing worth flagging early. A Fidelis Medicaid claim is a managed care claim, so the eMedNY fee-for-service rules do not govern it directly. That distinction matters most when you're arguing an exception, and the boundary is covered further down.

Ambetter from Fidelis Care and Essential Plan

Ambetter from Fidelis Care and Essential Plan claims are due within 90 calendar days of the date of service. Hospital UB-04 claims run 90 calendar days from the date of service or the date of discharge, per the QHP and Essential Plan Provider Manual V26.0.

That discharge trigger is easy to miss, and it's the reason inpatient claims behave differently from professional claims on the same account. For a 12-day admission, counting from admission instead of discharge costs you nearly two weeks.

The QHP and Essential Plan manual also publishes a short list of acceptable late-claim reasons. Those are covered in detail further down, along with the documentation Fidelis expects with them.

Wellcare By Fidelis Care Medicare Advantage and Dual Advantage

Wellcare By Fidelis Care Medicare Advantage and Dual Advantage claims in New York are due within 90 calendar days of the date of service, per the Fidelis Care V26.0 Medicare Advantage and Dual Advantage tip sheet effective January 1, 2026.

There's a conflict here that nobody publishes, and you should know about it. The national Wellcare Medicare Advantage provider manual sets 180 calendar days from the date of service or discharge. The New York plan-specific tip sheet sets 90 days.

For a Wellcare By Fidelis Care New York claim, the New York tip sheet is the document that governs. Applying the national 180-day figure to a New York dual claim is how practices lose them. When the two disagree, the plan-specific document wins.

Plan names changed for 2026 as well. Wellcare Fidelis Dual Plus (HMO D-SNP) is now Wellcare Fidelis Dual Align (HMO D-SNP). Same filing rules, new name on the card, and staff who search the old name will find outdated pages.

Fidelis Care New Jersey MLTSS

Fidelis Care New Jersey requires initial, corrected, and voided MLTSS claims within 6 months or 180 days from the Medicaid or primary insurance payment date, whichever is later, unless the Provider Participation Agreement states otherwise.

New Jersey also publishes adjudication timeframes New York does not. HIPAA-compliant electronic clean claims process within 15 calendar days of receipt, and manually submitted clean claims process within 30 calendar days.

When Does the Fidelis Filing Clock Start?

The Three Clocks Providers Confuse

Fidelis Care runs three separate filing clocks. Initial claims start on the date of service and run 90 calendar days. Corrected claims start on the remittance date and run 60 calendar days. Reconsiderations and claim disputes also start on the remittance date and run 60 calendar days.

Look at rows two and three. Both start at the remittance date, not the denial date. Billers who count from the letter in their hand give up days they were entitled to, and on a 60-day window a week matters.

The COB row is the one that surprises people. That clock doesn't start until the primary payer's EOB lands, which can be months after the service. It's a separate trigger, and it's the only one on the list that a third party controls.

Calendar Days, Business Days, and Weekend Deadlines

The Fidelis timely filing limit is measured in calendar days, not business days, across the New York lines of business. Weekends and holidays count against the window. The one published exception is the Ambetter QHP provider appeal of a medical necessity denial, which is stated as 60 business days from receipt of the denial.

A claim is filed when the payer receives it. Not when your biller hit submit, and not when the file left the clearinghouse. That gap is usually a day or two, sometimes longer if a batch stalls, and it comes out of your window.

Weekend deadlines are where people guess. Original Medicare publishes a rollover rule, so a deadline landing on a weekend or federal holiday moves to the next business day, and our Medicare filing deadline rules guide walks through how that works.

Fidelis doesn't publish an equivalent rollover for its New York lines. Don't assume one exists. If day 90 is a Saturday, treat Friday as your deadline and stop arguing with the calendar.

Picture the day-89 scramble. Records finally came back, the claim is clean, it's Friday afternoon, and someone asks whether Monday still counts. Nobody in the office knows. That question should never come up, because the claim should have gone out at day 60.

Fidelis Corrected Claim Timely Filing Limit and How to Submit One

The 60-Day Corrected Claim Window

Fidelis Care corrected claims must be submitted within 60 calendar days of the date of the remittance for the original claim. The claim frequency type code must be 7 for a replacement, and the original Fidelis Care claim number is required on every correction.

This rule is stable, not new. The same 60-day corrected claim window appears in Fidelis EDI provider guidance going back to 2018, and it was restated in a Provider Relations notice dated February 6, 2026. If someone tells you it changed recently, they're working from a bad source.

Electronic Corrected Claim Requirements

Electronic corrections have to carry specific segment values or Fidelis won't accept them. The requirements below come from the Fidelis Care corrected claim protocol published by Provider Relations.

• The original Fidelis Care claim number must be submitted
• REF segment: REF01 element equals F8, and the REF02 element carries the original Fidelis Care claim number
• 2300 Loop, CLM segment: CLM05-3 Claim Frequency Type Code must be set to 7 for replacement of a prior claim
• For a full retraction, the bill type must end in 8
• Only one correction per Fidelis Care original claim number should be submitted per day

That last rule trips up teams doing bulk corrections. Send two corrections against the same claim number on the same day and you've created a conflict, not a fix. Space them out or batch by claim, never by worklist.

UB-04 and CMS-1500 Corrected Claim Fields

Paper and form-level corrections carry their own field requirements. The frequency code alone is not enough on either form.

The Mistake That Closes the Window

Fidelis Care states that corrected claims must not be submitted using the Provider Appeals Form or the Provider Portal Claim Dispute feature. Claims not billed according to these guidelines are returned to the provider rather than denied, which is why clean claim submission matters more here than on a first-time claim.

Returned and denied are not the same thing, and the difference is expensive. A denial gives you a remittance and a dated record. A returned claim gives you neither, so nothing in your system shows the correction was ever attempted.

Meanwhile the 60-day clock keeps running. What usually happens is that the correction sits in the appeals queue, somebody follows up at day 45, and by then there isn't enough runway to rebuild and resubmit it properly.

Route the correction as a correction. That means the right frequency code, the right form fields, the original claim number, and the corrected claims address rather than the initial claims box.

Corrected Claim or Appeal? How to Choose the Right Route

A corrected claim changes data on a claim Fidelis Care already processed. An appeal asks Fidelis Care to review a determination. Both are due within 60 calendar days of the remittance date, but corrected claims must not be submitted through the Provider Appeals Form or the portal Claim Dispute feature.

Fidelis is explicit on this: an appeal is not for correcting billing errors, and it is not for first-time claims. The table below maps each situation to the route Fidelis expects.

Route selection works the same way across most payers, and the vocabulary shifts more than the logic does. Our breakdown of corrected claim versus reconsideration covers how another major payer draws the same lines.

Here's the part that earns the table. Four of those six rows run 60 calendar days from the same trigger. The window is identical. The route is not.

Picking wrong doesn't buy you time, it burns it. The misrouted submission comes back, the clock never paused while it sat in the wrong queue, and now you're rebuilding at day 50. Mailing addresses differ by request type as well, and Fidelis publishes them on its Fidelis Care appeal mailing addresses page.

When the route genuinely isn't obvious, look at what you're changing. Changing claim data is a correction. Challenging a decision Fidelis already made on data that was right is an appeal.

Fidelis Appeal and Reconsideration Timely Filing Limit

The 60-Day Window from Remittance

Fidelis Care requires claim reconsiderations, corrected claims, and claim disputes to be received within 60 calendar days from the date of the remittance, or per contract terms. Fidelis Care states it will make reasonable efforts to resolve appeal requests within 30 calendar days of receipt.

Two operational details sit underneath that. An incomplete appeal form can result in a delay or an outright denial of the request, so a half-filled form isn't a partial submission, it's a wasted one.

The second detail is the word received. The window closes on the date Fidelis has it, not the date you mailed it. Build a few days of mail time into a paper appeal or you're submitting late on paper you filed on time.

Where the 90-Day Figure Comes From

Three different Fidelis appeal windows circulate online, and each one is accurate within its own scope. Confusing them is what produces the wrong deadline on a real claim.

• 60 calendar days from remittance. New York lines of business, per the Fidelis Care Provider Manual V26.1 effective January 1, 2026.
• 60 business days from receipt of the denial. Ambetter QHP provider appeal of a medical necessity denial, per the QHP and Essential Plan Provider Manual V26.0.
• 90 days of the EOP date. Fidelis Care Medicaid Quick Reference Guide for New Jersey, which also sets claim payment policy disputes at 90 days from the denial date.

Notice that one of those is stated in business days while the other two are calendar days. On a 60-day window, that difference is roughly two extra weeks, and it only applies to one plan type.

A three-level appeal ladder with a 90-day first level shows up on several third-party payer databases. We could not confirm it against any Fidelis Care primary document, so treat it as unverified until Fidelis Provider Relations confirms it for your contract.

Saying that out loud costs nothing and protects you. A number you can't source is a number you shouldn't build a workflow around.

What Happens If You Miss the Fidelis Filing Deadline

CO-29 and What It Means

CO-29 is the claim adjustment reason code meaning the time limit for filing has expired, maintained by X12 claim adjustment reason codes. The CO group code places the balance on the provider rather than the patient. Institutional claims may carry remark code N390 instead.

Systems render it inconsistently. CO29 on one screen, CO-29 on another, CO 29 on a third. All three are the same adjustment, and searching only one spelling in your denial reports will undercount the problem.

New York Medicaid maps its own timeliness edits to the same code. Edit 00658 covers inpatient claims not submitted within required time limits, and edit 01007 covers institutional claims, both reported with CO 29 and HIPAA Claim Status Codes 187 and 188.

Missing the Fidelis timely filing limit has a blunt financial consequence. Unless federal law or CMS prohibits it, Fidelis Care may deny payment for claims received after the time limit in the Agreement for filing clean claims. Where your contract prohibits balance billing, that amount can't move to the patient either.

Can a Fidelis Timely Filing Denial Be Overturned?

A Fidelis Care timely filing denial can be disputed. Fidelis Care lists timely filing dispute as an appealable denial type in its QHP and Essential Plan provider manual. This differs from Original Medicare, where a late-filing denial is not an initial determination and the standard appeal process does not open at all.

That single difference decides whether a balance is worth working. On a Medicare CO-29, the appeal ladder never opens and a reopening request is the only path. On a Fidelis claim, a dispute route exists, and it's a documentation exercise rather than a dead end.

You still need proof, and the argument has to match the facts. Either the claim was filed on time and Fidelis has the wrong receipt date, or a different clock applied, or a recognized exception covers the delay. Sorting recoverable balances from real write-offs is what CO-29 denial recovery is built around.

Pick one argument and build it properly. Practices that submit all three at once signal they don't know which actually happened, and reviewers read it that way.

What Counts as Proof of Timely Filing for a Fidelis Claim

The Evidence Fidelis Names Itself

Fidelis Care names electronic acceptance reports as proof of timely submission on its Fidelis Care electronic transactions page. A 277CA claim acknowledgment establishes that Fidelis Care received a specific claim. A 999 functional acknowledgment confirms only that the transaction file was syntactically accepted, not that the claim was received.

Most billing teams treat those two reports as interchangeable. They aren't, and the gap between them is where timely filing disputes get lost.

A 999 says your file parsed. It's a syntax receipt for the envelope, and it tells you nothing about the claims inside. A 277CA speaks to individual claims and reports which ones were accepted and which were rejected at the front door.

Evidence Ranked From Strongest to Weakest

Not all proof carries the same weight in a dispute. The ranking below runs from payer-side evidence down to internal records, and our proof of filing evidence ranking for another major payer follows the same hierarchy.

Draw the line at the clearinghouse row. Everything above it speaks to what the payer received. Everything below it speaks to what your office did, and a dispute built on internal notes alone rarely survives review.

Rejected Is Not the Same as Denied

A rejected claim never entered adjudication, so Fidelis Care has no record of receiving it and the filing clock never stopped. A denied claim was received, processed, and adjudicated. Only the second one produces a remittance.

That's the distinction that decides most timely filing disputes. If your system shows a claim as submitted and Fidelis shows nothing at all, you had a rejection, and the deadline kept running the entire time it sat there looking fine.

Picture a clearinghouse report showing 40 claims transmitted on a Tuesday. Six of them rejected at the front door. Nobody opened the acknowledgment file, so those six read as submitted in the practice management system for the next 11 weeks. Steady keep disputed claims active work catches that at day 10, not day 89.

Build the check into the workflow rather than the calendar. A claim isn't done when it transmits. It's done when a Fidelis Care claim number exists for it.

Timely Filing Exceptions and Late Claim Reasons

Fidelis Care's Published Late Claim Reasons

Exceptions to the Fidelis timely filing limit are narrow and documented. The Fidelis Care QHP and Essential Plan Provider Manual V26.0 lists acceptable reasons for late claim submission: litigation, primary insurance processing delays, retroactive eligibility, and rejection of an original claim for reasons other than timely filing. Fidelis expects proof or an explanatory letter with the submission.

Those are Fidelis published examples for the QHP and Essential Plan line. They aren't a universal exception list for every Fidelis product, and your Participation Agreement still governs what your contract allows.

Notice what isn't on that list. Staff turnover, a billing system migration, and a practice falling behind on charge entry are not recognized reasons anywhere in the manual. Administrative oversight almost never qualifies as an exception with any payer.

The New York Medicaid Rule Behind the 90-Day Standard

New York State regulation 18 NYCRR 540.6 requires Medicaid claims to be initially submitted within 90 days of the date of service to be valid and enforceable, unless the delay is outside the provider's control. Claims submitted after 90 days must be submitted within 30 days from the time submission came within the provider's control.

That rule has been enforced since March 1978, which explains a lot about New York. It's why nearly every plan in the state lands on 90 days while payers in Texas and Florida sit at 95 days and a full year.

Read the second sentence again, because it's the part almost nobody publishes. Getting past 90 days doesn't hand you an open window. It hands you a fresh 30-day clock that starts the moment the obstacle clears.

eMedNY Delay Reason Codes and the Second 30-Day Clock

New York Medicaid fee-for-service runs three clocks, and the eMedNY general billing manual sets all three.

There's a correspondence in that table nobody has published. New York Medicaid fee-for-service allows 60 days to correct and resubmit from the date of notification. Fidelis Care allows 60 calendar days from the remittance for corrected claims. The managed care rule mirrors the state rule.

Claims aged past 90 days require a numeric delay reason code under HIPAA. The codes below come from eMedNY FOD-7001 delay reason codes, and each carries its own sub-clock.

Two traps sit in that table. Delay reason 6 is not accepted by New York Medicaid and will deny outright. Delay reason 9 stops being available once a claim has already denied for timely filing, so you can't use it to rescue a claim that's already been rejected on timeliness.

Where the Fee-for-Service Rule Stops and Managed Care Begins

Everything above governs New York Medicaid fee-for-service through eMedNY. Fidelis Care is a managed care organization, so a Fidelis claim is governed by the Fidelis Provider Participation Agreement and the Fidelis provider manual, not by eMedNY directly. Providers working through New York Medicaid enrollment guide requirements will recognize the same split on the enrollment side.

This matters because the delay reason codes are tempting. They're specific, they're documented, and they look like they'd solve a Fidelis problem. On a fee-for-service claim they will. On a managed care claim they may not apply at all.

Confirm exception handling with Fidelis Provider Relations before you build a workflow on a delay reason code. The state framework tells you what New York considers reasonable. Your contract tells you what Fidelis will actually accept.

Fidelis Secondary and Coordination of Benefits Claims

The COB Reconsideration Window

For Fidelis Care QHP and Essential Plan secondary claims, submit the claim with the primary carrier explanation of benefits for reconsideration within 90 calendar days of receiving that primary EOB. The coordination of benefits clock starts on receipt of the primary EOB, not on the date of service.

That's a completely different trigger from the initial claim window, and it's the single most useful fact in this section. It also means a service from 10 months ago can still be inside its secondary window if the primary payer only just adjudicated.

When another carrier turns out to be primary, Fidelis notifies the provider on a remittance advice to bill that payer first. Fidelis then coordinates benefits up to the Fidelis allowable as secondary.

Catching the primary carrier before submission is what 42 CFR 447.45 assumes states and plans will do, and it's why Medicaid sits last in the payment order.

New Jersey handles this differently again. The MLTSS 180-day window runs from the Medicaid or primary insurance payment date, whichever is later, so the trigger is baked into the same rule rather than split into a separate one.

Dual Eligible Billing Order

If the beneficiary is dually eligible, Medicare must be billed before Medicaid or NJ FamilyCare when the service is covered by Medicare. Medicare balances may be billed to the Medicaid or FamilyCare managed care organization once the Medicare benefit is exhausted.

Getting the order wrong doesn't just delay payment, it burns the window on both claims. Confirming coverage and payer order before the visit is cheaper than reconstructing it eight months later, which is the whole argument for verify coverage before billing as a front-end process.

Here's the operational risk nobody plans for. A primary payer takes seven months to adjudicate. The EOB finally lands, a separate 90-day clock starts that day, and it sits in someone's queue for six weeks because it looks like old paper.

Work the EOB the day it arrives. Not the week it arrives, and not when someone gets to the bottom of the stack.

Where to Send Fidelis Claims: Payer ID, Addresses, and Contacts

The Fidelis Care claims address depends on the claim form and the product, and the Fidelis payer ID for New York lines of business is 11315. The Fidelis claims address routing below is drawn from the Fidelis Care claims submission resources page.

Send professional and institutional claims to different boxes. Corrected claims and appeals go somewhere else entirely, and the Fidelis Care billing address you used last year may not be the one in use now.

Mail a corrected claim to the initial claims PO Box and it gets processed as a duplicate, not a correction. The address is part of the correction the same way the frequency code is, and getting one right while missing the other still fails.

Addresses and payer IDs verified against Fidelis Care provider materials on September 8, 2026. Confirm before any paper submission, because payer PO Boxes change more often than filing rules do.

How to Calculate Your Fidelis Filing Deadline

Worked Examples

To calculate a Fidelis Care filing deadline, count 90 calendar days forward from the date of service, beginning with the day after service. For a corrected claim, count 60 calendar days forward from the remittance date of the original claim.

Three counting rules keep this clean. Count calendar days rather than business days. Treat day 1 as the day after the date of service. Don't assume a weekend or holiday rollover exists on a Fidelis claim, so if day 90 lands on a Saturday, work to the Friday.

There's no official Fidelis timely filing limit calculator, so a worked table is the next best thing. Print it, or drop the four counting scenarios into whatever your team already uses to flag aging claims.

Set Internal Deadlines Before the Payer Cutoff

An internal deadline should sit well ahead of the payer window. The buffer absorbs the things that always happen: a front-end rejection, a records request, a coder out sick during a busy week.

A 30-day buffer on a 90-day window covers one rejection cycle and one round of records retrieval. Practices submitting at day 85 have room for neither. Building the same matrix across your full payer mix is the point of our payer deadline matrix example for a payer with far more variation than Fidelis.

One more change worth making. Work the aging report by deadline proximity rather than dollar amount. A $180 claim at day 84 is more urgent than a $2,400 claim at day 30, because only one of them is about to become unrecoverable.

How to Prevent Fidelis Timely Filing Denials

Preventing a Fidelis timely filing denial is a workflow problem, not a knowledge problem. Practices that lose claims almost always knew the Fidelis timely filing limit that applied. Five habits close the gap.

Bill within 48 hours of the encounter. The window is 90 days, and claims rarely miss it because 90 days wasn't enough. They miss it because charge capture sat unbilled for three weeks first, and then a rejection ate another two.

Confirm acceptance, not transmission. A task isn't finished when the file leaves the clearinghouse. It's finished when a Fidelis Care claim number exists. Until that check is built into the workflow, front-end rejections stay invisible for weeks.

Work rejections in a separate queue from denials. They're different problems with different urgency. A denial means the clock stopped and you have a remittance. A rejection means the clock never stopped at all.

Keep a payer deadline matrix by line of business. One row per Fidelis line, with the initial window, the corrected window, the appeal window, and the clock trigger for each. Update it whenever a new provider manual version publishes.

Reconcile unbilled encounters weekly. Every encounter with no claim attached is a timely filing denial waiting to happen. It won't show on an aging report either, because no claim exists yet for the report to age.

That last one is the quiet killer. AR reports only show claims that were actually filed, so the encounters nobody billed are invisible in exactly the report managers use to check for problems.

How MedSole RCM Protects Fidelis Claims Before the Deadline

Practices lose Fidelis claims for two reasons that have nothing to do with knowing the rules. Deadline ownership is unassigned, and front-end rejections never surface until the window is nearly gone.

On Fidelis accounts, we verify the controlling window by line of business rather than applying one number to every claim. Acceptance gets confirmed instead of transmission, and rejections get worked daily rather than weekly.

Aging is prioritized by deadline proximity, and corrections and disputes get routed through the right channel before the 60-day window closes. When a claim does deny, our denial management services team works the root cause rather than resubmitting the same claim.

What Full-Service RCM Costs at MedSole

MedSole RCM provides full-service medical billing at 2.99% of monthly collections and provider credentialing at $99 per insurance. Billing covers eligibility verification, claim submission, denial management, accounts receivable follow-up, and monthly reporting for practices across the United States.

The full scope runs wider than most percentage quotes include: eligibility verification, prior authorization, charge capture, ICD-10 and CPT coding review, claim scrubbing and electronic submission, ERA and EOB payment posting, denial management and appeals, accounts receivable follow-up, patient statement processing, and monthly performance reporting.

Percentage-based medical billing commonly runs 4% to 9% of collections across the industry. MedSole RCM prices full-service billing at 2.99% of monthly collections, and that figure covers the whole scope above rather than a stripped-down claims-only service.

Credentialing at $99 Per Insurance

MedSole RCM handles provider credentialing and payer enrollment at $99 per insurance, with continuous payer follow-up until approval. Industry credentialing pricing commonly runs $150 to $300 per payer. For New York practices, Medicaid credentialing for New York plans covers Fidelis Care alongside Healthfirst, MetroPlus, and EmblemHealth.

Credentialing delay is a timely filing problem, and most practices don't connect the two until it costs them. Claims held during a pending enrollment keep aging against a 90-day window that doesn't pause for paperwork.

That's how a 120-day credentialing timeline turns into written-off revenue. The enrollment finally approves, and half the held claims are already past 90 days from their dates of service.

Fidelis Timely Filing Questions Providers Ask

What is the Fidelis timely filing limit?

Fidelis Care requires initial claims within 90 calendar days of the date of service across its New York lines of business, including Medicaid, Child Health Plus, Essential Plan, Ambetter from Fidelis Care, and Wellcare By Fidelis Care Medicare and Dual Advantage, per V26.0 provider tip sheets effective January 1, 2026. Fidelis Care New Jersey MLTSS runs 180 days or 6 months. Your Provider Participation Agreement governs if it states a different window.

What is the Fidelis corrected claim timely filing limit?

Fidelis Care corrected claims are due within 60 calendar days of the remittance date for the original claim. The claim frequency type code must be 7 for a replacement, and the Fidelis Care original claim number is required on the submission. Corrected claims must not be sent through the Provider Appeals Form or the Provider Portal Claim Dispute feature, because those route to appeals rather than to claim correction.

What is the Fidelis appeal timely filing limit?

Fidelis Care requires reconsiderations and claim disputes within 60 calendar days of the remittance date, per the Fidelis Care Provider Manual V26.1 effective January 1, 2026. One published exception applies: an Ambetter QHP provider appeal of a medical necessity denial is stated as 60 business days from receipt of the denial. Calendar days and business days are not interchangeable on a 60-day window.

What is the Fidelis timely filing limit in California?

Fidelis Care does not operate in California. Fidelis Care serves New York, and Fidelis Care New Jersey operates as a separate company in New Jersey. If a plan appears on a California claim under a Fidelis name, check the member ID card, because Centene Corporation operates differently branded plans by state and the California entity will have its own filing rules and payer ID.

Can a Fidelis timely filing denial be appealed?

Yes, with proof. Fidelis Care lists timely filing dispute as an appealable denial type in its QHP and Essential Plan provider manual, which differs from Original Medicare, where a late-filing denial is not an initial determination and the appeal ladder never opens. Claims filed on time but denied for an unrelated reason are treated differently again, as the New York State Medicaid Update explains for fee-for-service. Our CO-29 denial support team reviews the claim history before anything gets drafted.

What proves a Fidelis claim was filed on time?

Claim-level acceptance carrying a Fidelis Care claim number is the strongest evidence. An accepted 277CA claim acknowledgment comes next, then a portal receipt with a tracking ID, then a certified mail receipt with a claim copy. A 999 functional acknowledgment confirms only that your file passed syntax checks, and internal billing notes establish staff activity rather than payer receipt.

What is the Fidelis Care payer ID?

The Fidelis Care payer ID is 11315 for New York lines of business, covering professional and institutional claims, eligibility, and electronic remittance. Dates of service before June 1, 2020 may still route under legacy WellCare of New York payer ID 14163. Confirm the payer ID against the member ID card, because Fidelis Care New Jersey and Wellcare products do not all share the same identifier.

Does Fidelis count calendar days or business days?

Fidelis Care states its New York filing windows in calendar days for initial claims, corrected claims, and reconsiderations, so weekends and holidays count against the window. The published exception is the Ambetter QHP provider appeal of a medical necessity denial, which is stated in business days. Fidelis does not publish a weekend rollover for its New York lines, so do not assume one applies.

What does medical billing cost and how is credentialing priced?

MedSole RCM provides full-service medical billing at 2.99% of monthly collections and provider credentialing at $99 per insurance. Billing covers eligibility verification, claim submission, denial management, accounts receivable follow-up, and monthly reporting. Percentage-based billing across the industry commonly runs 4% to 9% of collections, and credentialing commonly runs $150 to $300 per payer, so the comparison is worth running against any quote you receive.

Sources, Verification, and How This Guide Is Maintained

Every deadline in this guide was traced to a Fidelis Care primary document, a New York State regulation, or a federal regulation. Third-party payer databases were reviewed and excluded as sources, because the figures they publish conflict with each other and with Fidelis Care's own materials. Where sources disagree, both figures appear above with their origins named.

Verified against Fidelis Care provider documents on September 8, 2026.

Fidelis Care primary sources: provider tip sheets V26.0 effective January 1, 2026, Provider Manual V26.1 effective January 1, 2026, and the Provider Relations corrected claim notice dated February 6, 2026.

Also: the Fidelis Care Quick Reference Guide dated May 2026, the Required Request Form page for administrative reviews and provider appeals, and the Fidelis Care New Jersey MLTSS Filing Claims page.

New York State sources: 18 NYCRR 540.6, eMedNY FOD-7001 on submitting claims over 90 days from the date of service, the eMedNY Information for All Providers General Billing manual, and the New York State Department of Health Medicaid Update. Federal and standards sources: 42 CFR 447.45 and the X12 claim adjustment reason code list.

Correction Policy and Review Cadence

Payers change filing rules and publish new manual versions without much notice. If a figure here no longer matches your current Fidelis Provider Participation Agreement or the current Fidelis provider manual, tell us and we'll verify it and update the page.

This guide is reviewed quarterly and whenever Fidelis Care publishes a new provider manual version. Updates are posted to the MedSole RCM medical billing blog with a revised verification date.