Educational Materials

A CMS-mandated program, the Chronic Care Improvement Program (CCIP) is designed to reduce hospitalizations for our Medicare members diagnosed with congestive heart failure. The program is closely aligned with the Million Hearts Campaign, which has a goal of significantly reducing the number of strokes and heart attacks over five years.

Similarly, the Quality Improvement Program (QIP) is designed to reduce all-cause re-admissions for Medicare members who have a heart failure diagnosis by focusing on medication adherence and care coordination. The QIP is aligned with the national Partnership for Patients campaign.

Fidelis Care is proud to provide the following links to additional information on best practices and clinical guidelines:

American College of Cardiology: Heart Failure and Cardiomyopathies 

Fidelis Care is committed to supporting members with chronic diseases through programs that help them better manage their health through a combination of education and care planning.

Once diagnosed, members can access our disease management programs in two ways: written information that is mailed to their home, or one-on-one phone outreach from a Nurse Case Manager. 

In addition, Fidelis Care Complex Case Managers help members who need extra health support. 

We provide important educational information in our newsletters and on our website, fideliscare.org, as well as through customized letters, brochures, and other materials that are sent to members.

Through our Disease Management and Complex Case Management Nurse Case Managers, Fidelis Care connects with members individually on a regular basis, helping to:

• Prevent or manage disease complications
• Coordinate care and appointments with primary care providers and specialists
• Coordinate care with caregivers and family members
• Manage medications
• Arrange for in-home equipment or services for more independent living
• Connect with community resources and services
• Make positive lifestyle changes
• Provide moral support

Fidelis Care’s Disease Management and Complex Case Management Nurse Case Managers also serve as a direct link between our members and their health care providers. We regularly contact provider offices by phone, fax, or letter to alert them of changes in a member’s health status or care, as well as to collect relevant medical data that may help us provide better service and assistance.

Fidelis Care regularly evaluates the effectiveness of our Disease Management and Complex Case Management programs, and we value your feedback and participation in this process. 

If you have questions or feedback about a specific Fidelis Care disease management program, complex case management programs or would like to refer a patient to one of our programs, please call 1-800-247-1441, or email triage@fideliscare.org.

Fidelis Care is proud to be your partner in providing the highest quality care and service to our members and your patients. 

Clinical Practice Guidelines have been developed to aid the practitioner in clinical decision-making for specific circumstances. Guidelines describe appropriate clinical care procedures and processes based on the best available scientific and peer-reviewed evidence and wide-ranging consensus—the main source for evidence-based care. The goal of evidence–based care is to support quality of care and consistency in healthcare delivery.

The United States Preventive Service Task Force (USPSTF) is a website containing recommendations for preventive health care services in primary care developed through scientific evidence reviews of clinical research. These recommendations can be found via ahrq.gov or uspreventiveservicestaskforce.org.

Choosing Wisely is an initiative of the ABIM Foundation that seeks to advance a national dialogue on avoiding unnecessary medical tests, treatments, and procedures. Choosing Wisely provides learning modules for clinicians to enhance communication skills, avoid unnecessary testing and overcome barriers to delivering high-value care.

Additionally, many professional organizations such as the American Academy of Pediatrics, the American Association of Clinical Endocrinologists, and the American College of Physicians develop clinical practice guidelines specific to their area of medical specialty.

Self-Help and Resource Guide (PDF)

Empower Your Behavioral Health Patients Brochure  (PDF)

Evidence Based Practices Resource Center

NYS Office of Addiction Services and Supports (OASAS) LOCADTR Resources

Prevent Suicide NY

Suicide Prevention Lifeline

National Institute for Mental Health Resources 

HealthierLife Performance Improvement Project

Improving Cardiometabolic Health for Members with Diabetes | Tip Sheet (PDF)

Provider Reference Guide (PDF)

Smoking Cessation Tip Sheet(PDF)

Behavioral Health Uniform Network Provider Training Program

Fidelis Care participates in a collaboration with New York State Health Plan Association, Center for Practice Innovations, and the Center on Addiction to provide a uniform clinical online training in core competencies to licensed OMH clinics and PROs providers, as well as licensed OASAS clinic programs statewide. Programs are strongly encouraged to take advantage of this training resource.

Learn how to get started

Fidelis Care has partnered with the American Cancer Society (ACS), the New York State and City Departments of Health, and leaders of New York’s health care community to reduce the burden of cancer in New York. This collaborative, facilitated by the New York State HPV Coalition, is focused on increasing the human papillomavirus (HPV) vaccination rate among adolescents 11 and 12 years of age.

We need your help in promoting HPV vaccination.

Read more about this important initiative:

HPV Vaccination and Cancer in New York State (PDF)

Top 10 Tips for HPV Vaccination Success

** Learn more about the HPV vaccine.** 

Perinatal PIP Provider Brochure (PDF)

National Imaging Associates, Inc. (NIA) Authorization Program Effective October 1, 2019
Fidelis Care has engaged National Imaging Associates, Inc., a Magellan Healthcare Company, to coordinate a prior authorization program that manages outpatient (office and hospital) habilitative and rehabilitative physical medicine services, including services rendered in the home, effective October 1, 2022.

This program is consistent with industry-wide efforts to manage the increasing utilization of these services and to ensure quality of care. All providers will be required to obtain prior authorization for physical medicine services, which includes physical therapy, occupational therapy, and speech therapy.

This program will include the following Fidelis Care health insurance products:

• Medicaid Managed Care (NYM)
• Child Health Plus(CHP)
• HealthierLife (HARP)
• Qualified Health Plans ("Metal-Level Products)
• Essential Plan (EP)

Submitting Prior Authorization Requests

• There are two preferred ways to submit prior authorization - either through the NIA website at www.RadMD.com or by calling NIA at 1-800-424-4952.
• To get started, go to www.RadMD.com click the New User button and submit a RadMD Application for New Account by selecting “Physical Medicine Practitioner.” Your RadMD login information should not be shared.

Further details regarding this prior authorization program can be found by viewing the resource links below.

• Physical Medicine Prior Authorization - Quick Reference Guide for Providers
• FAQ - Fidelis Care Physical Medicine Services Prior Authorization
• Fidelis Care Physical Medicine Request - Tip Sheet/Checklist

Clinical guidelines can be found by visiting the NIA website at www.RadMD.com

Pediatric Toolkit for Providers (PDF)

To support the critical role that pediatricians and primary care physicians play in the early identification and access to treatment for emotional disturbances in children, the New York State Office of Mental Health (OMH) is funding a collaborative effort of State and County governments with medical providers designed to link pediatricians and primary care physicians with child mental health experts across New York State.

Project TEACH (Training and Education for the Advancement of Children’s Health) will provide specialized training, consultation and linkage with mental health treatment for primary care physicians statewide.  It is a collaboration of OMH with the Department of Health (DOH), Conference of Local Mental Hygiene Directors, American Academy of Pediatrics (AAP) and the New York State Academy of Family Physicians (AAFP).

Review evidence based questionnaires and rating scales for the screening, diagnosis, and monitoring of  a range of behavioral health needs for pediatricians. 

For more information, visit the Project TEACH website, the New York State Office of Mental Health website, or contact Dr. David Kaye, Project Director at 716-887–5775.

• Fidelis Care Medical Specialty Solutions - Musculoskeletal Surgery (Spine) Utilization Review Matrix 2024
• Fidelis Care Medical Specialty Solutions - Musculoskeletal Surgery (Hip, Knee, and Shoulder) Utilization Review Matrix 2024

Additional Resources

• New York Chiropractic College

Weight Assessment and Counseling Message from Dr. Marchello (PDF)

Preventive Care Assessment Form for Children and Adolescents (PDF)

Medicaid Children's Improvement Project - Important Guidelines for Infants and Toddlers

Weight Assessment and Counseling for Children/Adolescents (WCC) - Provider Letter

Health Equity Resources for Health Care Professionals

• New York City Department of Education (DOE) Health Screening Guidance

The Office of Children and Family Services is dedicated to improving the integration of services for New York’s children, youth, families and vulnerable populations; to promoting their development; and to protecting them from violence, neglect, abuse and abandonment. OCFS is responsible for programs and services involving foster care, adoption and adoption assistance, child protective services including operating the Statewide Central Register for Child Abuse and Maltreatment, preventive services for children and families, services for pregnant adolescents, and protective programs for vulnerable adults. 

Office of Children and Family Services | Home | Office of Children and Family Services (ny.gov)

Fidelis Care 29-I Facilities List

Member Satisfaction Survey (ECHO)

Provider BH ECHO Training Introduction

How to Access the Provider ECHO Training