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Fidelis Care would like to inform providers of an upcoming change to the Comprehensive Psychiatric Emergency Program (CPEP) rate code 4009 for Crisis Outreach Service Visits.  Effective July 1, 2024 rate code 4009 will be retired for Medicaid plans, including HIV Special Needs Plans (HIV SNPs), and Health and Recovery Plans (HARPs).  With the announced State Plan Amendment (SPA) approval for Crisis Intervention services, CPEPs are allowed to bill utilizing the mobile crisis rate codes for both adults and children.   If you have any questions, please contact your Fidelis Care Provider Relations Specialist. To find your designated representative, please visit Contact Your Designated

The Medicaid Drug Rebate Program (MDRP), established by the Omnibus Budget Reconciliation Act of 1990 (OBRA '90), requires that drug manufacturers to enter into an agreement with the Centers for Medicare and Medicaid Services (CMS) to provide rebates for drugs covered by Medicaid. Reimbursement for practitioner-administered drugs is only allowed if the drug qualifies for rebate in accordance with 42 USC 1396r-8.   Providers are encouraged to use the tools below to determine if a practitioner-administered drug will be reimbursable through Fidelis Care Medicaid and HARP plans.  Claims submitted with NDC numbers that are not on the list of approved manufacturers will

Fidelis Care is has been made aware that Ambetter from Fidelis Care and Essential Plan members received ID cards with incorrect billing information located on the back of the ID card. Please do not use the Payor ID or the Claims address listed on the member ID card, unless the information below is present.   The correct information is as follows: Ambetter from Fidelis Care – Payor ID – 11315 Medical Claims Address – Fidelis Care, PO Box 724, Amherst, NY 14226-0724 Essential Plans – Payor ID – 11315 Medical Claims Address –

Fidelis Care is pleased to inform you that the most recent 2023 QARR Non-Compliance 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 12/12/2023.  Please refer to the most recent "Non-Compliance Report" instruction letter to understand the information being provided on each tab of the Excel Spreadsheet.  Please notify any staff involved with quality management and advise that these documents have been posted. If you have any questions, please call the Provider Call Center at 1-888-FIDELIS (1-888-343-3547).

In an effort to continue promotion of quality improvement for services provided to Fidelis Care members, as of January 1, 2024, Fidelis Care expanded its existing partnership with Evolent (NIA) to provide the management and prior authorization of non-emergent Musculoskeletal (MSK) procedures including: inpatient and outpatient hip, knee, shoulder, lumbar and cervical spine surgeries.   Fidelis Care encourages providers to use the new Prior Authorization Requirement Lookup Tools to determine which procedure codes require pre-authorization for Medicaid (including Child Health Plus and HARP products), Medicare, Essential Plans, and Qualified Health Plans (Ambetter from Fidelis Care).   To access the lookup tool on fideliscare.org: Navigate