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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

Fidelis Care will host three Provider Office Hours in October 2024. During the webinar, Fidelis Care staff will be available to share information, explain different resources, and answer your questions. Provider Office Hours – October 2024 Topic: Back to Basics – Doing Business with Fidelis Care When:  Thursday, October 10th – 9AM – 10AM EST Click here to register*   Topic: Behavioral Health Overview When:  Thursday, October 24th – 2PM – 3PM EST Click here to register*  

The following sections of the Fidelis Care authorization grids have been updated effective November 1, 2024.   The following codes have been added to the Medicaid DME Authorization Grid:   A4543 Supplies for transcutaneous electrical nerve stimulator, for nerves in the auricular region, per month A4544 Electrode for external lower extremity nerve stimulator for restless legs syndrome

Fidelis Care would like to inform providers of Medicaid requirements when medical records are lost due to an unforeseen event.  Providers whose records have been damaged, lost, or destroyed are required to report that information as soon as practicable, but no later than thirty calendar days after discovery, to the New York State (NYS) Office of the Medicaid Inspector General (OMIG) Self-Disclosure Unit. Failure to report such incidents may result in a determination of overpayment, penalties, and/or sanctions. Please note: Loss/destruction/ corruption/inaccessibility of electronic records due to data corruption, theft, change in data vendor or other issues must also be included