¡Bienvenidos, proveedores!

The following sections of the Fidelis Care authorization grids have been updated effective January 1, 2025.   The following codes have been updated on the Medicare, Medicaid, Essential Plan, and Metal-Level Products Authorization Grids and require prior authorization: III.       Outpatient surgery: The following services require prior authorization:                   D.  Skin surgery and other dermatological procedures: 15011, 15012               H.  Eyelid & ocular surgery: 66683                                                                                                                                   P. CAR-T Therapy: 38225, 38226, 38227, 38228                                                                                                                                 Q. Urology: 51721, 53865, 53866, 55881, 55882                                                                                                                                  R. Other: 60660, 60661                                                                                                                   V.        Outpatient and DME Services: The following services require prior authorization:               A.    Diagnostic testing     

As part of New York’s Medicaid Redesign Team (MRT) initiative, the NY 1115 Waiver introduced the Social Care Networks (SCN) Program, a transformative model focused on integrating social care into healthcare delivery. There is growing recognition that fully achieving health for all requires a focus not only on physical and behavioral health, but also on Health-Related Social Needs (HRSN). The SCN program encourages partnerships across health and social services to address Medicaid members' diverse needs, such as food insecurity, housing instability, and lack of transportation. Many of these HRSN services may become reimbursable to a member under the provision of

Fidelis Care has partnered with Ophelia to provide free, fully virtual opioid use disorder treatment for all Fidelis Care, Ambetter from Fidelis Care, and Wellcare by Fidelis Care members. Ophelia is available in every county in New York State. Ophelia is a treatment provider available at no additional cost to members with opioid use disorder. Their mission is to make high-quality, evidence-based Medications for Opioid Use Disorder (MOUD) care affordable and accessible to all.  Ophelia’s services include: Easy referral process, available 7 days a week Judgment-free care specialized in opioid use disorder treatment 100% remote, no transportation needed Care is fully covered

Fidelis Care will host two Provider Office Hours in December 2024. During the webinar, Fidelis Care staff will be available to share information, explain different resources, and answer your questions. Provider Office Hours – December 2024   Topic: Pharmacy Overview When:  Thursday, December 5th – 2PM – 3PM EST Click here to register*   Topic: Fidelis Care and Wellcare Quality Programs When:  Tuesday, December 10th – 1PM – 2PM EST Click here to register*  

Beginning Nov. 18, you can validate eligibility and benefits, submit claims, check claim status, submit authorizations, and access Fidelis Care payer resources via Availity Essentials. Availity experts are hosting several live webinar sessions to help you get ready. Here’s a look ahead at what tools and functionality are coming, paired with live training to learn more. Space is limited, save your seat today!   Availity Essentials Introduction Monday, Nov. 18 – 3 p.m. EST Monday, Dec. 2 – 2 p.m. EST Authorization Tools Tuesday, Nov. 19 – 2 p.m. EST Tuesday, Dec. 3

As you may know, the United States is experiencing an IV fluid shortage after Hurricane Helene.  Fidelis Care would like to provide guidance regarding prior authorization (PA) requests that may be affected by this shortage.   Medications for use in Non-Oncology Diagnoses (PA Requests Submitted Directly to Fidelis Care Pharmacy) Fidelis Care is aware of the IV Fluid supply chain issues and has processes in place to consider the impacts of the IV Fluid shortages when reviewing medication Prior Authorization (PA) requests, for as long as the shortage is in effect. Providers must include communication and/or documentation that the medication Prior Authorization