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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 02/19/2024.  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’s Pharmacy Services would like to provide further 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

March 30 is National Doctors Day. On this annual observance, Fidelis Care extends sincere gratitude to the doctors and healthcare professionals across New York State who work tirelessly to support the health and wellness of the members and local communities we serve. Your service and dedication to achieving enhanced patient outcomes through quality care is a vital pillar of Fidelis Care’s mission of transforming the health of the community. First commemorated in 1933 by Eudora Brown Almond to honor the contributions of local physicians in Barrow County, Georgia, March 30 was selected because that was the day in 1842 that Dr. Crawford

The following sections of the Fidelis Care authorization grids have been updated effective May 1, 2024.   The following codes have been added on the Medicaid, Medicare, Essential Plan, and Metal-Level Products Authorization Grids and require prior authorization: C9166   secukinumab C9167   apadamtase alfa C9168   mirikizumab-mrkz J0177    aflibercept hd J0589    daxibotulinumtoxina-lanm J1202    miglustat J1203    cipaglucosidase alfa-atga J1323    elranatamab-bcmm J2277    motixafortide J2782    avacincaptad pegol J2801    risperidone (Rykindo) J3055    talquetamab-tgvs J7165    prothrombin complex concentrate (Balfaxar) J9073    cyclophosphamide (ingenus) J9074    cyclophosphamide (sandoz) J9075    cyclophosphamide, not otherwise specified J9248    melphalan (hepzato) J9249    melphalan (apotex) J9376    pozelimab-bbfg Q5133  tocilizumab-bavi (tofidence) Q5134  natalizumab-sztn (tyruko)   The following codes have been added on the Medicare Authorization Grids and require prior authorization: J0577    buprenorphine extended-release (brixadi), less than or equal to 7 days of therapy  J0578   

Beginning March 2, 2024, current enrollees in Qualified Health Plans (Ambetter from Fidelis Care) who are within 200-250% FPL were notified via letter from NY State of Health about the expansion of Essential Plan (EP) coverage in New York State. Members that now qualify for Essential Plan coverage will automatically be moved from their Qualified Health Plan to Essential Plan 200-250, effective April 1, 2024. In addition to the Essential Plan Expansion, effective April 1, 2024, NYS will be implementing the EP Pregnancy Choice Provision.  Individuals who are currently in EP and who report being pregnant will remain EP eligible, instead