¡Bienvenidos, proveedores!

Fidelis Care is pleased to inform you that the medical record request letter and details for 2023 HEDIS/QARR have been posted on our Provider Portal, Provider Access Online (PAO). Please review these materials and send the requested documentation to Fidelis Care as soon as possible. Thank you in advance for your cooperation on this important matter. Should you have any questions or concerns, please do not hesitate to contact Fidelis Care’s Provider Call Center at 1-888-FIDELIS (1-888-343-3547). As part of the New York State Quality Assurance Reporting Requirements (QARR), National Committee for Quality Assurance (NCQA), and HEDIS reporting requirements for the Centers

Fidelis Care is pleased to announce a new Prior Authorization Requirement Lookup Tool to help improve the experience of providers. The new, web-based tools will help providers determine which procedure codes require pre-authorization for Medicaid (including Child Health Plus and HARP products), Medicare, and Qualified Health Plans (Ambetter from Fidelis Care).   Streamlined Access for Providers: Access the lookup tool on fideliscare.org: Navigate to Providers Under Provider Resources, find Authorization Grids Click on the Medicaid, Child Health Plus, HealthierLife (HARP), Medicare or Qualified Health Plan drop-down menu Select Authorization Lookup Tool at the top of the menu   Benefits of the New Tool: Faster

The following sections of the Fidelis Care authorization grids have been updated effective March 1, 2024.   Evolent (New Century Health) will require review of the following codes for Medicaid, Essential Plans and Metal-Level Products: J8999 eflornithine (Iwilfin) J8999 nirogacestat (Ogsiveo)   Evolent (New Century Health) will require review of the following codes for Medicare Products: J8999 eflornithine (Iwilfin) – Part D only J8999 nirogacestat (Ogsiveo) – Part D only   The following codes have been added to the Medicaid DME Authorization Grid and requires prior authorization:   A4540 Distal transcutaneous electrical nerve stimulator, stimulates

Fidelis Care will host two unique Provider Office Hours in February 2024. During the interactive Zoom sessions, Fidelis Care staff will be available to share information, explain different resources, and answer your questions. Provider Office Hours – February 2024 Topic: Back to Basics – Doing Business with Fidelis Care When:  Wednesday, February 7th – 9AM – 10AM Click here to register*   Topic: Behavioral Health When:  Thursday, February 29th - 3PM - 4PM Click here to register*  

Fidelis Care would like to remind our providers of new fax numbers being used throughout the organization.  Please begin using the fax numbers listed below immediately. Please note: Utilization Management and Pharmacy fax numbers have been updated for further clarification.   Department Previous Fax Number New Fax Number Type of Faxes  Behavioral Health Authorization Requests