Добро пожаловать, Брокеры!

Fidelis Care has partnered with Pomelo Care to provide free 24/7 online pregnancy and infant care to eligible Medicaid Managed Care, HealthierLife (HARP), Essential Plan, and Ambetter from Fidelis Care Qualified Health Plan members. Effective June 1, 2024, Pomelo Care is available in the following counties: Bronx, Chautauqua, Erie, Greene, Lewis, Niagara, Putnam, Seneca, Steuben, Suffolk, Warren, and Westchester. Pomelo Care is a program available at no additional cost to eligible Fidelis Care members who are pregnant or had a baby within the last three months. Pomelo provides 24/7 pregnancy and infant care via SMS, phone, or virtual visits.   Pomelo Care’s Services:

Fidelis Care would like to make providers aware of a scheduled outage of the Fidelis Care Provider Portal.  Beginning at 10PM EST Friday, June 14, through 4PM EST Saturday, June 15, the Provider Portal will be unavailable due to an upgrade of supporting systems.   In addition, our Fidelis Care Interactive Voice Response (IVR) and Real-Time Eligibility Calls (X12 270/271) accessed through our Call Center will also be unavailable.   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

The New York State Department of Health (DOH) is required to verify provider qualifications, training, and staffing requirements (i.e., background checks) annually and report this information to the Centers for Medicare and Medicaid Services (CMS), under the terms of the 1915(c) Children’s Waiver.   All HCBS Providers, HHCMs, and C-YES who provide HCBS or care management to Children’s Waiver participants are required to report this information to DOH electronically through the Staff Compliance Tracker. Agencies must ensure that information related to staff qualifications, training, and background checks for any staff who provided services to youth from March 1, 2023-April 30, 2024, is

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