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The Recipient Restriction Program (RRP) is a medical review and administrative mechanism whereby New York State (NYS) Medicaid members with a demonstrated pattern of abusing or misusing NYS Medicaid services may be restricted to a specific healthcare provider (i.e., hospital, clinic, physician) or pharmacy to coordinate services. RRP is administered by the Office of the Medicaid Inspector General (OMIG) in coordination with local Departments of Social Services (LDSS).   When there is a need for a member to be assigned to the RRP, Fidelis Care will contact the appropriate healthcare provider to obtain a verbal and/or written agreement stating the provider agrees

Fidelis Care is pleased to make the following webinars available to our provider partners.  These webinars will provide information to support proper coding and documentation of coding and documentation of patient risk factors Each webinar includes an overview of Risk Adjustment (RA) and Hierarchical Condition Categories (HCCs). To register, please click on the link next to the webinar you would like to attend. 2024 CMS Model and ICD-10 Updates Jan 16, 2024 @ 10:00AM | https://centene.zoom.us/meeting/register/tJ0uf-usrzgpGtx6TUrMFGlSMYm3iNc-aXsy Jan 17, 2024 @ 12:00 PM | https://centene.zoom.us/meeting/register/tJEqc-qppjgsHNc1F0AlMFejQ9K_tKatjNog Jan 18, 2024 @ 5:00 PM | https://centene.zoom.us/meeting/register/tJAkdeCtrTIoG9UYWE4UWP2TE0YkQ_UXMwZ7 Jan 19, 2024 @ 2:00PM | https://centene.zoom.us/meeting/register/tJ0sdeCuqz4uGN0BzaltbOjRRrwNAADaRjY1 Jan 23, 2024

As your health plan partner, Fidelis Care would like to share important updates about the public health emergency unwind and the renewal performance experienced since July 2023 in Medicaid Managed Care, Essential Plan, Child Health Plus, HARP, and MLTC programs across New York State. Based on the first several months, approximately 78% of Fidelis Care members have successfully recertified and maintained their health insurance. This early performance is closely aligned with data shared by New York State in the Public Health Emergency Unwind Dashboard, and we continue to examine new opportunities to further improve these outcomes. As a Fidelis Care provider,

As you know, Fidelis Care relies upon the receipt of membership information from the New York State Department of Health (SDOH) prior to issuing capitation payments. The date for receiving this information from the SDOH varies from month to month. In certain months, the availability of data may be delayed as much as one week. Nevertheless, Fidelis Care has historically made capitation payments as close to the first of each calendar month as possible.  Presented below is Fidelis Care’s 2024 capitation check and Electronic Funds Transfer (EFT) schedule. Please refer to this to determine the timing of your monthly payment.  Over

Fidelis Care is pleased to inform you that the most recent 2023 QARR Non-Compliance 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 11/14/2023.  Please refer to the most recent "Non-Compliance Report" instruction letter to understand the information being provided on each tab of the Excel Spreadsheet.  Please notify any staff involved with quality management and advise that these documents have been posted. If you have any questions, please call the Provider Call Center at 1-888-FIDELIS (1-888-343-3547).