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The following section of the Fidelis Care authorization grids has been updated effective September 1, 2026.             The following section of the Medicaid, CHP, Essential Plan, Ambetter Metal-Level Plans, and Medicare Authorization Grids and requires prior authorization: III.       Outpatient surgery: The following services require prior authorization:                                 D.  Skin surgery and other dermatological procedures: Q4110, Q4111           The following codes have been added to the Medicaid, CHP, Essential Plan, Ambetter Metal-Level Plans, and Medicare Authorization Grids and require prior authorization: J0528 fosfomycin disodium J2374 apraclonidine hcl J7176 fibrinogen-chmt (Fesilty)   Visit:  Authorization Grids

Effective September 1, 2026, Fidelis Care will implement the Leveling of Care: Emergency Department Evaluation and Management (E/M) Overcoding for Facility Services Policy (CC.PP.80) for applicable lines of business. This policy is designed to help ensure facility Emergency Department E/M coding accurately reflects the level of resources used during a patient visit. Claims will go through a review prior to payment to determine if the billed level of service is supported by the claim evidence and resources.  This approach is consistent with national billing guidance and industry oversight priorities. Both the Centers for Medicare & Medicaid Services (CMS) and the Office of

Fidelis Care will host three Provider Office Hours in August 2026. During the webinars, Fidelis Care staff will be available to share information, provide an overview of provider resources, and answer your questions. Provider Office Hours – August 2026 Topic: Fidelis Care – Back to Basics When:  Thursday, August 13th – 12PM – 1PM EST Click here to register*   Topic: Fidelis Care and Wellcare Quality Programs When:  Wednesday, August 19th – 10:30AM – 11:30AM EST Click here to register*

Effective August 1, 2026, Fidelis Care will implement a new pre-pay claims review process for certain claims that may involve Third-Party Liability (TPL) or Workers' Compensation coverage. This initiative is designed to help ensure claims are billed to the appropriate payer and processed accurately. As part of this effort, Fidelis Care has partnered with Machinify, a leader in subrogation, TPL identification, and Coordination of Benefits services, to support the review of select claims that may be related to accidents, injuries, or other situations where another insurer may have primary payment responsibility. What Types of Claims May Be Reviewed? Claims that indicate an accident