Bienvenidos, Corredores!

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. GLP-1 agonists are primarily approved for the treatment of type II diabetes. Inappropriate prescribing of medications like Ozempic and Mounjaro for treatment of obesity has contributed to shortages of these medications for patients with type II diabetes.2,3 Fidelis Care will actively monitor and review prior authorization (PA) requests to ensure these medications are used only per their FDA-approved indications. Requests for documentation to substantiate attestations made in the PA request process

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. Starting November 1, 2024 , newly enrolled members and members who renew their coverage will have 30 days to self-select a PCP. If a member does not designate a PCP within the 30 days following renewal or enrollment, Fidelis Care will assign the member a PCP, similar to the Medicaid assignment process. Members will receive a letter from Fidelis Care with the PCP they are assigned. Please note: Any member that has renewed in the past six

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. Click here to view the full list of standards, including situations and timeframes.   For additional questions, or if we can be of assistance in any way, please contact your Fidelis Care Provider Engagement Account Manager. To find your designated representative, please click here. 

To streamline the authorization process and expedite member care, the following Durable Medical Equipment (DME) codes no longer require prior authorization.   Effective immediately, the following codes no longer require prior authorization for Medicaid, CHP, and HARP products:   A4239 SUPPLY ALLOWANCE FOR ADJUNCTIVE, NON IMPLANTED CGM A6540 GRADIENT COMPRESSION STOCKING, WAIST LEN E0562

Fidelis Care is pleased to inform you that the most recent 2024 QARR/HEDIS Care Gap Report has been posted on Provider Access Online (provider portal). This information is indicative of all encounter data on file with Fidelis Care as of 8/19/2024.  This report provides you with the opportunity to review preventative services for which Fidelis does not show your members as receiving in the measurement period.  We strongly suggest that you review the report for opportunities to either render the service, schedule the service to be done before 12/31/24 or if previously performed, submit supplemental data by 2/1/25.  Please notify