Ambetter from Fidelis Care
How To Submit Claims To Ambetter from Fidelis Care
Provider-side claims submission guidance for Ambetter from Fidelis Care, including channels, payer IDs, paper addresses, and follow-up resources.
For Ambetter from Fidelis Care, the practical claims workflow usually starts with electronic submission guidance and only falls back to paper instructions when the payer documents a mailing address for specific claim types or exceptions. The details below keep the workflow broad instead of reducing it to a single address.
At a glance
- Fidelis Care/QHP claims may be submitted electronically or on paper. The unique EDI payer ID is 11315. The provider manual lists paper claim mailing addresses by claim type, and the electronic transactions page says Availity is the preferred clearinghouse; Inovalon and other clearinghouses are also accepted. Provider portal access is available for claims status.
Submission channels
- Electronic claims via Availity clearinghouse
- Electronic claims via Inovalon clearinghouse or another clearinghouse
- Direct electronic 837 submission after eCommerce enrollment
- Paper CMS-1500
- Paper UB-04
Electronic claims payer IDs
- 11315
Paper claims addresses
- Fidelis Care, PO Box 724, Amherst, NY 14226-0724
- Fidelis Care, PO Box 806, Amherst, NY 14226-0806
- Fidelis Care, PO Box 898, Amherst, NY 14226-0898
- Fidelis Care, PO Box 905, Amherst, NY 14226-0905
Corrected claims and follow-up
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Submit corrected claims with the original claim number.
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Use frequency type code 7 for replacement of prior claim or 8 for void.
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Electronically, set CLM05-3 to 7 and include the original claim number in REF02 with REF01 = F8.
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Only one correction for a Fidelis Care original claim number should be submitted per day.
Caveats
- Paper address varies by claim type; verify whether the claim is professional, institutional, or COB-related.
- The manual’s paper addresses are for QHP/EP; the Ambetter FAQ says Ambetter claims continue to be submitted directly to Fidelis Care at the listed address.
- Claims status is available through Provider Access Online / provider portal.
Provider resources
- Provider Access Online (Provider Portal) (official)
- Electronic Transactions (official)
- Authorization Grids / Authorization Lookup Tool (official)
- Manuals, Forms and Policies (official)
- Ambetter from Fidelis Care Provider FAQ (official)
Sources
| Fact | Value | Source | Confidence |
|---|---|---|---|
| EDI payer ID | Fidelis Care Payer ID Number 11315 – For EDI Claims Only. | Official | high |
| Preferred clearinghouse | Fidelis Care’s preferred clearinghouse for electronic claims submission is Availity. | Official | high |
| Electronic submissions | Claims can also be submitted through Inovalon or another clearinghouse. | Official | high |
| Paper claim addresses | QHP/metal-level paper claims: PO Box 724 (medical claims); PO Box 898 (CMS-1500); COB PO Box 905; Essential Plan uses PO Box 806. | Official | high |
| Corrected claim instructions | Original claim number required; frequency type code 7 or 8. | Official | high |
| Provider portal claims status | Provider Access Online provides access to claims status, authorizations, eligibility, and benefits. | Official | high |
Last reviewed: March 27, 2026
Sources used: 3 official