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HomeMemberHelpful ToolsHealth ResourcesSocial Determinants of HealthGiving Back

Giving Back to Our Communities

Fidelis Care and the Centene Foundation Award $1.1 Million to The Jed Foundation to Protect the Mental Health of New York’s Youth

Funding will help expand emotional well-being resources, educational workshops, and training programs for community-based organizations that foster communities of care statewide

September 20, 2024, NEW YORK CITY —  Fidelis Care, a leading health insurer providing quality, affordable coverage to New Yorkers, and the Centene Foundation, the philanthropic arm of Centene Corporation, announced today a $1.1 million grant to The Jed Foundation (JED), a national nonprofit that protects emotional health and prevents suicide for teens and young adults.

With this grant, JED will expand its current services, providing at least five youth-serving community-based organizations (CBOs) with consultation or strategic planning services, including expert guidance, educational workshops, and training programs, equipping young people with life skills and connecting them to mental health care when they are in distress.

“We are thrilled to support the vital work of The Jed Foundation with this grant,” said Vincent Marchello, Chief Medical Officer at Fidelis Care. “At Fidelis Care, we recognize the importance of mental health services in creating healthier communities. This investment underscores our commitment to ensuring youth and adolescents have access to the critical support they need to thrive.”

According to the Substance Abuse and Mental Health Services Administration (SAMHSA), it is currently estimated that nearly one in five 12- to 17-year-olds in the United States experience a major depressive episode every year, and almost half of teens 13 to 17 say they would seek out professional help only as a last resort. In New York State, the need for enhanced mental health support for school-aged youth is critical: in 2021, 57% of New York 12- to 17-year-olds with depression had not received any care in the last year.

“JED is grateful to Fidelis Care and the Centene Foundation for their commitment to supporting the emotional well-being of New York youth and for providing the resources to help them thrive,” said John MacPhee, JED Chief Executive Officer. “This partnership will allow us to bring JED’s lifesaving work to community-based organizations across the state and help them build on their mental health safety nets and approaches, while positively impacting the lives of thousands of young people.”

The inaugural group of CBOs includes Bottom Line, an organization that partners with degree-aspiring students from first-generation and low-income backgrounds as they get into and through college and launch mobilizing first careers; Hetrick-Martin Institute, which provides free, year-round programs and services for LGBTQIA+ youth and allies aged 13 to 24 in New York City; and Prep for Prep, which provides first-rate educational, leadership development and professional advancement opportunities for young people of color in New York City.

"Through decades of experience at Bottom Line, we have seen that the condition of a student's mental health plays a significant role in their overall journey to becoming a college graduate and professional,” said Sheneita R. Graham, Director of Culturally Responsive Programming at Bottom Line. “Our role at Bottom Line is to build strong relationships that assist us in determining need and connecting students to resources that will help them thrive personally to persist academically. Partnering with The Jed Foundation grants us the opportunity to expertly assess our mental health policies, processes, and resources to ensure we provide our students with thoughtful, high-quality support."

"Hetrick-Martin Institute is pleased to be working with The Jed Foundation to improve our ability to recognize young people in distress and conduct suicide risk assessments," said Bridget Hughes, Chief Program Officer at Hetrick-Martin Institute.

"We are so grateful to The Jed Foundation for hosting two workshops for our incoming college freshmen as part of our annual College Transition Retreat,” said Corey Rhoades, Director of Undergraduate Affairs at Prep for Prep. “The presenters shared their expertise and tailored the sessions in a way that was uniquely relevant and engaging for our students."

To learn more about ways to provide community-based organizations with consulting, evidence-based best practices, and data-driven guidance to protect youth mental health and prevent suicide, visit JED’s website.

Fidelis-JED-Social

Screener Program Provides Support to Families Impacted by Social Determinants of Health

SDoH-chart

Fidelis Care’s innovative SDoH screener program was launched two years ago as a grassroots health equity initiative to address conditions in the environments where people are born, live, work, and play that affect their health, well-being, and quality of life. Social Determinants of Health can affect a wide range of health risks and outcomes – particularly among vulnerable populations and in underserved areas.

The screener enables trained Fidelis Care representatives to assess an individual’s immediate needs and challenges related to SDoH through a brief series of questions covering areas such as access to transportation, food, and secure and safe housing. More than 450,000 Fidelis Care members have participated to date.


Click here to learn more about the different Social Determinants of Health and find available resources.

More News:


Fidelis Care Pharmacy Benefits and Authorizations
8/28/2024 • Posted by Provider Relations in Provider News

Fidelis Care’s Pharmacy Services would like to provide clarification on how medications are covered under member’s medical and pharmacy benefits.

 

Medications Covered Under Fidelis Care Medical Benefit

  • Physician Administered Drugs – medications administered to a member during the course of an outpatient visit
    • Providers obtain medication via “buy-and-bill” or shipment to their practice site from a vendor of their choosing.
    • Coverage is dictated by Fidelis Care Authorization Grids, Prior Authorization Lookup Tool and/or Evolent Specialty Services (formerly NCH) Authorization Grids (Oncology Regimen Specific).
    • Medical Benefit Authorization Grids are plan specific.
    • If a medication is listed on one of the above Authorization Grids, a prior authorization is required prior to use/billing date of service in order to receive payment.
    • If a medication is not listed, no prior authorization needed
  • Physician administered drugs remain in-scope under the Fidelis Care Medical Benefit for Medicaid & HARP members (not impacted by NYS Pharmacy Benefit transition).
  • Medical Benefit Pharmacy prior authorizations can be faxed, submitted electronically via ePA, and/or called in to Fidelis Care directly.

 

Line of Business

Medical Benefit Initial Request Fax Number

Medical Benefit Appeals Request Fax Number

Medicare

844-235-5090

833-757-0611 (only for Part B)

Medicaid, CHP, EP, & Ambetter

844-235-5090

844-235-5091

 

Medications Covered Under Fidelis Care Pharmacy Benefit

  • Coverage is dictated by Fidelis Care Formularies.
    • Members obtain medications from community or retail outpatient pharmacies.
    • Pharmacy Benefit Formularies are plan specific.
    • Each formulary clearly indicates if a medication requires a prior authorization or not.  Non-formulary (NF) medications also require authorization prior to the prescription being filled at a community or retail outpatient pharmacy.
    • As of 4/1/2023, Medicaid & HARP Pharmacy benefits are administered by the NYS NYRx program. Visit the NYRx program website for information on the NYRx Preferred Drug List (PDL) and Prior Authorization submission requirements.
  • Pharmacy Benefit Pharmacy Prior Authorizations can be faxed, submitted electronically via ePA, and/or called in to Fidelis Care directly.

 

Line of Business

Pharmacy Benefit Initial Request Fax Number

Pharmacy Benefit Appeals Request Fax Number

Medicare

844-235-5021

866-388-1766

CHP, EP, & Ambetter

844-235-4852

888-865-6531

 

If you have any questions, please contact your Fidelis Care Provider Engagement Account Manager. To find your designated representative, please click here. 


Fidelis Care Pharmacy Benefits and Authorizations
8/28/2024 • Posted by Provider Relations in Provider News

Fidelis Care’s Pharmacy Services would like to provide clarification on how medications are covered under member’s medical and pharmacy benefits.

 

Medications Covered Under Fidelis Care Medical Benefit

  • Physician Administered Drugs – medications administered to a member during the course of an outpatient visit
    • Providers obtain medication via “buy-and-bill” or shipment to their practice site from a vendor of their choosing.
    • Coverage is dictated by Fidelis Care Authorization Grids, Prior Authorization Lookup Tool and/or Evolent Specialty Services (formerly NCH) Authorization Grids (Oncology Regimen Specific).
    • Medical Benefit Authorization Grids are plan specific.
    • If a medication is listed on one of the above Authorization Grids, a prior authorization is required prior to use/billing date of service in order to receive payment.
    • If a medication is not listed, no prior authorization needed
  • Physician administered drugs remain in-scope under the Fidelis Care Medical Benefit for Medicaid & HARP members (not impacted by NYS Pharmacy Benefit transition).
  • Medical Benefit Pharmacy prior authorizations can be faxed, submitted electronically via ePA, and/or called in to Fidelis Care directly.

 

Line of Business

Medical Benefit Initial Request Fax Number

Medical Benefit Appeals Request Fax Number

Medicare

844-235-5090

833-757-0611 (only for Part B)

Medicaid, CHP, EP, & Ambetter

844-235-5090

844-235-5091

 

Medications Covered Under Fidelis Care Pharmacy Benefit

  • Coverage is dictated by Fidelis Care Formularies.
    • Members obtain medications from community or retail outpatient pharmacies.
    • Pharmacy Benefit Formularies are plan specific.
    • Each formulary clearly indicates if a medication requires a prior authorization or not.  Non-formulary (NF) medications also require authorization prior to the prescription being filled at a community or retail outpatient pharmacy.
    • As of 4/1/2023, Medicaid & HARP Pharmacy benefits are administered by the NYS NYRx program. Visit the NYRx program website for information on the NYRx Preferred Drug List (PDL) and Prior Authorization submission requirements.
  • Pharmacy Benefit Pharmacy Prior Authorizations can be faxed, submitted electronically via ePA, and/or called in to Fidelis Care directly.

 

Line of Business

Pharmacy Benefit Initial Request Fax Number

Pharmacy Benefit Appeals Request Fax Number

Medicare

844-235-5021

866-388-1766

CHP, EP, & Ambetter

844-235-4852

888-865-6531

 

If you have any questions, please contact your Fidelis Care Provider Engagement Account Manager. To find your designated representative, please click here.