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The following sections of the Fidelis Care authorization grids have been updated effective July 1, 2024.   The following codes have been added on the Medicaid, Essential Plan, and Ambetter By Fidelis Care Metal-Level Products Authorization Grids and require prior authorization: Q5137  ustekinumab-auub (Wezlana), biosimilar, subQ Q5138  ustekinumab-auub (Wezlana), biosimilar, intravenous J0911   Instillation, taurolidine and heparin sodium (hemodialysis) J1748   infliximab-dyyb (Zymfentra) J2267   Injection, mirikizumab-mrkz J3247   Injection, secukinumab, intravenous J3263   Injection, toripalimab-tpzi J3393   Injection, betibeglogene autotemcel J3394   Injection, lovotibeglogene autotemcel J7171   Injection, Adamts13, recombinant-krhn J7355   Injection, traveoprost, intracameral implant J8611    Methotrexate (jylamvo) J8612    Methotrexate (Xatmep) J9361    Injection, efbemalenograstim alfa-vuxw   Evolent Oncology Program (New Century Health) will require review of the following codes for Medicaid, Medicare, Essential Plans and Metal-Level Products: J2468    Injection, palonsetron hydrochloride (avyxa) J3263    Injection, toripalimab-tpzi J8611    Methotrexate

Fidelis Care will host two Provider Office Hours in June 2024. During the webinar, Fidelis Care staff will be available to share information, explain different resources, and answer your questions. Provider Office Hours – June 2024 Topic: Back to Basics – Doing Business with Fidelis Care When:  Thursday, June 13th – 9AM – 10AM EST Click here to register*   Topic: Credentialing and Provider Data Management When:  Thursday, June 27th – 3PM – 4PM EST Click here to register*

Due to technical issues, providers may have been experiencing difficulty accessing Fidelis Care’s Provider Portal. Full functionality of the portal has now been restored. Please log in as you normally would. We appreciate your patience as we resolved the issue. If you have any questions, please contact your Fidelis Care Provider Relations Specialist. To find your designated representative, please visit Contact Your Designated Provider Relations Specialist. Thank you for being a valued Fidelis Care partner in the provision of quality care.

Fidelis Care is aware that some providers are having access issues with the Provider Portal.  The IT Team is actively working on a solution and we will advise you when the issues have been resolved.    For additional questions, or if we can be of assistance in any way, please contact your Fidelis Care Provider Relations Specialist. To find your designated representative, please visit Contact Your Designated Provider Relations Specialist. Thank you for being a valued Fidelis Care partner in the provision of quality care.

Fidelis Care has been notified that the MCG Cite Guideline Transparency Tool will be upgraded to the 28th edition effective Friday, May 17, 2024. Providers can access this tool through the Fidelis Care Provider Portal. The Summary of Changes can be accessed from the main search page or any content product table of contents on the MCG website.  In addition, providers can review the Summary of Changes for the 28th edition content release. As a reminder, with the MCG Cite Guideline Transparency Tool, Fidelis Care can share clinical indications with providers. The tool is a secure resource that helps meet regulations around transparency