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HomeProvidersProvider ResourcesQuality Information

Provider Quality

Provider-Quality


To ensure a continued focus on quality, Fidelis Care is dedicated to engaging with providers to ensure our members get the best care possible. Quality is a critical component of the work we do at Fidelis Care. The Provider Relations Department works diligently to support providers in quality improvement initiatives.


Hearthands

Quality Care Incentives (QCI) Program

Fidelis Care's QCI Program rewards groups/practices for providing recommended preventive care, for caring for members with chronic disease, and for comprehensive obstetrical care. As your health plan partner, we remain committed to rewarding our providers for achieving high-quality outcomes and have made significant changes to the program for measurement year 2024 to align with our shared goals, encourage participation, and recognize regional differences within New York State.

Fidelis Care’s Quality Care Incentives (QCI) Program is available on Provider Access Online. Once logged in, please navigate to the File Downloads section to access the brochure.

Within the brochure, we are providing a summary of the components of our QCI Program, along with the associated coding specifications, to help you drive improvements in quality and to reward you for your efforts. Fidelis Care also provides monthly care gap reports to track your incremental performance, and identify those patients who may benefit from needed care and services.

If you have any questions regarding Fidelis Care’s Quality Care Incentives, please contact your Provider Partnership Associate. Use our Contact Provider Relations page for help.


Provider Access Online

Verify member eligibility or renewal status, check claims, send e-scripts, and more.

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Provider Office Hours

Fidelis Care hosts webinars called “Provider Office Hours” several times each month to share information and answer any of your questions. 
Find out more

Provider Satisfaction Survey

Your provision of quality care and services to our members contributes greatly to Fidelis Care’s success. One of the ways Fidelis Care prioritizes quality is making sure you are satisfied with your experiences. Our annual Provider Satisfaction Survey identifies areas to focus on for further improvement in the coming year. The Provider Relations Department works diligently to identify an action plan to address areas of improvement, while continuing to develop actions and interventions to improve the provider experience.

Resources

Fidelis Care offers resources including Provider Bulletins, tip sheets, educational materials, blog posts, and more to keep you informed.


 

FALL 2024 PROVIDER BULLETIN


  • Smoking Cessation Products and Medications
  • Helping Patients with Chemical Dependency
  • Appropriate Use of GLP-1 Agonists
  • Preventive Cancer Screenings and Vaccinations
  • Cardiovascular Disease and Statin Therapy

 

Vol. 10 Issue 4 (PDF)

 

Provider Quality News


Invitation to Fidelis Care’s January Provider Office Hours
12/16/2024 • Posted by Provider Relations in Provider News, Provider Quality

Office Hours

Fidelis Care will host three Provider Office Hours in January 2025. During the webinar, Fidelis Care staff will be available to share information, provide an overview of provider resources, and answer your questions.

Provider Office Hours – January 2025

Topic: Fidelis Care – Back to Basics
When:  Thursday, January 9th – 9AM – 10AM EST
Click here to register*

 

Topic: Claims and COB Overview
When:  Thursday, January 23rd – 2PM – 3PM EST
Click here to register*

 

Topic: Fidelis Care and Wellcare Quality Programs – Back to Basics
When:  Wednesday, January 29th – 2PM – 3PM EST
Click here to register*

*Attendance will be limited to the first 300 registrants for each session.
 


The Back to Basics session will include:

  • Important Updates/Information
  • Product Portfolio
  • Credentialing and Demographic Changes
  • Authorization Requirements
  • Vendor Information
  • Claims and Billing Information
  • Provider Tools & Resources

 

The Claims sessions will include:

  • Appeals Overview
  • Coordination of Benefits (COB) Information
  • Online Resources and Tools

 

The Quality - Back to Basics session will include:

  • Quality Overview: Why is Quality Improvement Important? What are my Scores and Opportunities? What reports are available to me? How do I get involved with my PPA?
  • Differences between Provider Engagement Account Manager (PEAM) and Provider Partnership Associate (PPA)
  • Care Gap Reporting: Measure Overview and Member Details
  • Importance of APV/MWOV
  • New 2025 Provider Tip Sheets/Resources
  • CPT II Coding/CDI Webinars
  • Supplemental Data Submission Onboarding (SuDS) for MY2025
  • E-Connectivity Implementation

 

Once you have registered, you will receive a confirmation email.  If you have any questions, please contact your Fidelis Care Provider Engagement Account Manager or Provider Partnership Associate. To find your designated representative, please visit Contact Provider Relations on our website.