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The following sections of the Fidelis Care authorization grids have been updated effective October 1, 2024.   The following has been added to the Medicare, Medicaid, Essential Plan, and Ambetter By Fidelis Care Metal-Level Products Authorization Grids and requires prior authorization:   Behavioral Health - Outpatient services: Transcranial Magnetic Stimulation (TMS) - Covered; Authorization Required for CPT Codes 90867, 90868 and 90869            Requests for members can be made by email qhcmbh@fideliscare.org, fax (833-561-0098) or by calling 1-888-FIDELIS (1-888-343-3547) and following the prompts for Behavioral Health, or dialing extension 16072.                                 Members over 18 years old may be eligible for this service when TMS is administered using an FDA-cleared

Fidelis Care’s Pharmacy Services would like to provide clarification on how medications are covered under member’s medical and pharmacy benefits.   Medications Covered Under Fidelis Care Medical Benefit Physician Administered Drugs – medications administered to a member during the course of an outpatient visit Providers obtain medication via “buy-and-bill” or shipment to their practice site from a vendor of their choosing. Coverage is dictated by Fidelis Care Authorization Grids, Prior Authorization Lookup Tool and/or Evolent Specialty Services (formerly NCH) Authorization Grids (Oncology Regimen Specific). Medical Benefit Authorization Grids are plan specific. If a medication is listed on

Fidelis Care would like to inform providers of a new Fidelis Care Visit Attestation Form for ABA (Applied Behavioral Analysis), that is used for Applied Behavioral Analysis authorization reviews.   Please ensure your practice has the Fidelis Care Visit Attestation Form on file and includes it for any future Applied Behavioral Analysis authorization submissions to Fidelis Care.  The visit attestation form is available here on Fideliscare.org.   For additional questions, or if we can be of assistance in any way, please contact your Fidelis Care Provider Engagement Account Manager. To find your designated representative, please visit Contact Your Designated Provider Relations Specialist. Thank you for being

Fidelis Care launched our Wellness 360 for Health Homes Webinar Series in 2023 as an effort to provide our Health Homes and their networks with information and resources to continue providing the highest quality of care for our membership. We are excited to announce that the webinar series will return starting Wednesday October 9th, 2024, at 10AM! The first topic will be 'Maternal Health and Care Management'.  See below for additional topics and all registration links. Every effort will be made to get the prepared slides out to registrants ahead of the webinar. However, the webinar will be recorded, and the

Fidelis Care would like to notify our providers that service Fidelis Care New Jersey members (previously WellCare of New Jersey) with updated information on claim submission and other important contact information.    Claim Submissions: Fidelis Care New Jersey wants to ensure that claims are handled as efficiently as possible. Providers can help facilitate timely claim payment by having an understanding of our processes and requirements. Additional information can also be found here.   Please Note:  Fidelis Care New Jersey encourages providers to submit claims electronically via electronic data interchange (EDI) or direct date entry (DDE).  Fidelis Care's preferred EDI gateway is Availity.  Providers can also use

Grants of $10,000 to $20,000 aimed at addressing maternal health disparities, especially in underserved communities   Deadline to apply is 5 p.m. ET on Friday, September 6, 2024   Fidelis Care, a statewide health plan with more than 2.4 million members in New York State and a Centene Corporation company, has opened the application process for its second annual maternal health grant program. Health care providers and community-based organizations across New York State that address maternal health disparities, particularly in underserved communities, are encouraged to apply for the grants, which range from $10,000 to $20,000. The application deadline is 5 p.m. ET on Friday, September 6, 2024. “Fidelis Care