Ambetter from Fidelis Care Timely Filing Limit

The most important thing to confirm with Ambetter from Fidelis Care is not just the number of days, but also what event starts the clock. Some payer documents measure from date of service, some from discharge, and some publish different rules for corrected claims or appeals.

At a glance

• For QHP/metal-level plans, claims must generally be submitted within 90 days of the date of service. Corrected claims must be submitted within 60 days of the remittance advice for the claim. The manual also notes certain late-filing exceptions and requires supporting proof or explanation.

Initial claim filing limits

• 90 calendar days from the date of service for QHP/metal-level claims

Corrected claim filing limits

• 60 days from the remittance advice for the claim

Appeal and reconsideration deadlines

• Provider appeal of medical necessity denial: within 60 business days of receiving the denial

Trigger basis and caveats

• Initial filing limit is tied to date of service for standard claims.
• Corrected claim limit is tied to the remittance advice date for the original claim.
• Appeal deadline is tied to the provider's receipt of the denial.
• Timely filing may be controlled by provider contract language and plan-specific rules.
• The cited deadlines are from the QHP/EP provider manual and should not be assumed to apply to other Fidelis Care lines of business.

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