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Beginning March 2, 2024, current enrollees in Qualified Health Plans (Ambetter from Fidelis Care) who are within 200-250% FPL will be notified via letter from NY State of Health about the expansion of Essential Plan 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. Fidelis Care is prepared to support our members and providers throughout this transition and will communicate frequently with those affected. We are making every effort to ensure continuity of care by directly reaching out to high-risk

The following sections of the Fidelis Care authorization grids have been updated effective April 1, 2024.   The following codes have been updated on the Medicare, Medicaid, Essential Plan, and Metal-Level Products Authorization Grids and require prior authorization: H.  Therapeutic Services:                                                            1.      Pain Management Codes (i.e. injections, TENS, therapeutic services): 20526, 20550, 20551, 20552, 20553, 21073, 27096, 62263-62264, 62273, 62280, 62281, 62282, 62290, 62320, 62321, 62322, 62323, 62324, 62325, 62326,  62327, 63622, 64400-64530, 64553-64595, 64600-64640, 64582, 64583, 64628, 64629                                         Note: 63622 does not require authorization for requests from

Вы просили, и мы услышали! Fidelis Care рада сообщить о новой функции на Портале поставщиков услуг, позволяющей поставщикам услуг подавать споры по претензиям в электронном виде. С помощью этого простого в использовании нового инструмента поставщики услуг могут подавать повторные заявки COB, апелляции по претензиям или повторное рассмотрение претензий.

Fidelis Care is pleased to announce that the new Quality Care Incentives (QCI) Program is now available on Provider Access Online. Once logged in, please navigate to the File Downloads section to access the brochure.   Fidelis Care's QCI Program rewards groups/practices for providing recommended preventive care, for caring for members with chronic disease, and for comprehensive obstetrical care. As your health plan partner, we remain committed to rewarding our providers for achieving high-quality outcomes, and have made significant changes to the program for measurement year 2024 to align with our shared goals, encourage participation, and recognize regional differences within New York State.     For

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