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In an effort to improve the quality of care for our members, Fidelis Care will be requesting Essential Plan members select a Primary Care Provider (PCP) starting in 2024.  The initial outreach will begin with members renewing their coverage as of March 1, 2024.  Members will be prompted by our Renewal Team to select a PCP when renewing their coverage.  If a member does not designate a PCP, Fidelis Care will assign a PCP to the member.   Providers are encouraged to share with their patients the benefits of having a PCP to ensure health care needs are addressed during annual physicals

Fidelis Care is pleased to announce that, effective January 1, 2024, Express Scripts® began processing pharmacy claims for our plan members. Express Scripts is a pharmacy benefit management (PBM) company serving more than 100 million Americans. Express Scripts Pharmacy delivers specialized care that puts patients first through a smarter approach to pharmacy services. Providers can direct members to call the Member Services phone number listed on their ID card should they have questions about this change. Alternatively, Fidelis Care has created an Express Scripts FAQ for providers to reference in order to assist members. The FAQ also includes information on mail order

Fidelis Care has received notice from New York State that the NYRx Helpline for members will be transitioning to an existing Medicaid Helpline.  The dedicated NYRx Medicaid Helpline will be decommissioned within the next year, and members will be instructed to call the existing Medicaid Helpline at (800) 541-2831. Updated member ID Cards will be issued to all members that are affected in anticipation of the transition. 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.

The Recipient Restriction Program (RRP) is a medical review and administrative mechanism whereby New York State (NYS) Medicaid members with a demonstrated pattern of abusing or misusing NYS Medicaid services may be restricted to a specific healthcare provider (i.e., hospital, clinic, physician) or pharmacy to coordinate services. RRP is administered by the Office of the Medicaid Inspector General (OMIG) in coordination with local Departments of Social Services (LDSS).   When there is a need for a member to be assigned to the RRP, Fidelis Care will contact the appropriate healthcare provider to obtain a verbal and/or written agreement stating the provider agrees

As your health plan partner, Fidelis Care would like to share important updates about the public health emergency unwind and the renewal performance experienced since July 2023 in Medicaid Managed Care, Essential Plan, Child Health Plus, HARP, and MLTC programs across New York State. Based on the first several months, approximately 78% of Fidelis Care members have successfully recertified and maintained their health insurance. This early performance is closely aligned with data shared by New York State in the Public Health Emergency Unwind Dashboard, and we continue to examine new opportunities to further improve these outcomes. As a Fidelis Care provider,