¡Bienvenidos, proveedores!

Fidelis Care would like to share important information regarding improvements to our provider payment methods. To reduce the environmental impact of our payments and to enhance the provider experience, all providers not currently enrolled with EFT, will be issued via Virtual Credit Card (VCC) beginning in November 2024.   The VCC program administered by Optum Financial, Inc. and ECHO Health Inc., is a widely used payment option in healthcare that we are making available to our provider network. Providers wishing to receive electronic funds transfer (EFT) rather than VCC payments may elect to do so through the instructions provided further below.   VCC Payments VCC

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 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

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