Fidelity Health Care Announces Partnership with Carelon

Premier Pulse     June 2023

Carelon is a post-acute third-party administrator focused on utilization management and claims processing for home health and post-acute facilities for some Medicare HMOs. Fidelity’s partnership with Carelon is specific to the Anthem Medicare population.

Fidelity was the first home care agency to participate in the Wound Connect Care Conference program trhough Carelon. Care Conferences occur weekly with a Fidelity wound nurse and a Carelon wound nurse. During the care conference visit, documentation, photos, wound treatment, and measurements are discussed to determine the best wound care options for healing.  To date, the Carelon wound nurses have been impressed with the wound care provided by Fidelity and have had no treatment change recommendations. Data will be gathered for patients entering the program, wound type, and healing times.

Fidelity’s goal is to obtain the best patient outcomes, decrease utilization, and increase reimbursement. This program has allowed Fidelity to highlight the exceptional work of its certified wound nurses. 

In exchange for participation in the Wound Connect program, Fidelity receives additional reimbursement for each skilled nursing visit provided to the wound care patients enrolled in the Wound Connect program. The estimated increased revenue for this program is $150,000 annually. In addition, this partnership will allow Fidelity to certify an additional 10 to 15 wound nurses annually to support our current wound team of 10.

Back to the June 2023 issue of Premier Pulse

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