Welcome, Providers!

Fidelis Care would like to share important information regarding improvements to our provider payment methods.

Fidelis Care celebrates National Healthcare Quality Week October 20 – 26, 2024. This week, we thank our doctors, social workers, nurses, and other healthcare professionals who make sure our members get the best care possible. We are also working to make things even better by listening to our members’ healthcare experiences to improve their quality of care. We are certified by the National Committee of Quality Assurance to ensure the quality of care you receive is always improving. Plus, we teach our members how to stay healthy with tips and resources. By focusing on detecting health problems early and preventing them, Fidelis Care helps our members stay healthy and avoid serious illness.

Fidelis Care has noted many recent requests for GLP-1 agonists (particularly Ozempic and Mounjaro) that appear to be intended for use outside of the FDA-approved indications for the product.

To improve the quality of care for our members, Fidelis Care began requiring that Essential Plan members select a primary care provider (PCP) as of April 1, 2024.

Access to quality care is important to eliminate health disparities and increase the quality and years of healthy life for all New Yorkers. The NYSDOH requires that certain Access and Availability Standards be met by PCPs, OB/GYNs, specialists, and behavioral health providers where applicable.

To streamline the authorization process and expedite member care, the following Durable Medical Equipment (DME) codes no longer require prior authorization.