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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 4/21/2024.  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

The following sections of the Fidelis Care authorization grids have been updated effective July 1, 2024.   The following codes have been added on the Medicaid, Essential Plan, and Ambetter By Fidelis Care Metal-Level Products Authorization Grids and require prior authorization: Q5137  ustekinumab-auub (Wezlana), biosimilar, subQ Q5138  ustekinumab-auub (Wezlana), biosimilar, intravenous J0911   Instillation, taurolidine and heparin sodium (hemodialysis) J1748   infliximab-dyyb (Zymfentra) J2267   Injection, mirikizumab-mrkz J3247   Injection, secukinumab, intravenous J3263   Injection, toripalimab-tpzi J3393   Injection, betibeglogene autotemcel J3394   Injection, lovotibeglogene autotemcel J7171   Injection, Adamts13, recombinant-krhn J7355   Injection, traveoprost, intracameral implant J8611    Methotrexate (jylamvo) J8612    Methotrexate (Xatmep) J9361    Injection, efbemalenograstim alfa-vuxw   Evolent Oncology Program (New Century Health) will require review of the following codes for Medicaid, Medicare, Essential Plans and Metal-Level Products: J2468    Injection, palonsetron hydrochloride (avyxa) J3263    Injection, toripalimab-tpzi J8611    Methotrexate

Fidelis Care will host two Provider Office Hours in June 2024. During the webinar, Fidelis Care staff will be available to share information, explain different resources, and answer your questions. Provider Office Hours – June 2024 Topic: Back to Basics – Doing Business with Fidelis Care When:  Thursday, June 13th – 9AM – 10AM EST Click here to register*   Topic: Credentialing and Provider Data Management When:  Thursday, June 27th – 3PM – 4PM EST Click here to register*

Due to technical issues, providers may have been experiencing difficulty accessing Fidelis Care’s Provider Portal. Full functionality of the portal has now been restored. Please log in as you normally would. We appreciate your patience as we resolved the issue. If you have any questions, please contact your Fidelis Care Provider Relations Specialist. To find your designated representative, please visit Contact Your Designated Provider Relations Specialist. Thank you for being a valued Fidelis Care partner in the provision of quality care.

Fidelis Care is aware that some providers are having access issues with the Provider Portal.  The IT Team is actively working on a solution and we will advise you when the issues have been resolved.    For additional questions, or if we can be of assistance in any way, please contact your Fidelis Care Provider Relations Specialist. To find your designated representative, please visit Contact Your Designated Provider Relations Specialist. Thank you for being a valued Fidelis Care partner in the provision of quality care.