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The following section of the Fidelis Care authorization grids has been updated effective July 1, 2026.             The following codes have been added to the Medicaid, CHP, Essential Plan, Ambetter Metal-Level Plans, and Medicare Authorization Grids and require prior authorization: 0636U   Babesia (Babesiosis), antibody detection of 20 recombinant protein groups, IgG 0637U   Babesia (Babesiosis), antibody detection of 20 recombinant protein groups, IgM 0638U  Bartonella (Bartonellosis), antibody detection of 32 recombinant protein groups, IgG 0639U   Bartonella (Bartonellosis), antibody detection of 32 recombinant protein groups, IgM   Visit:  Authorization Grids

Effective August 1, 2026, Fidelis Care will implement a Site of Care Optimization Program to promote cost-effective, high-quality care for members receiving infusion therapies enrolled in Essential Plans. Under this initiative, providers will be asked to transition eligible members from outpatient hospital infusion settings to clinically appropriate home infusion or ambulatory infusion suite (AIS) options. Infusion Providers: Visit fideliscare.org/Find-A-Doctor#/search for a complete list of contracted providers.   Program Highlights: Focuses on therapies for conditions such as immune globulin disorders, Crohn’s disease, rheumatoid arthritis, psoriasis, multiple sclerosis, and rare diseases. Supports improved access for members in rural or underserved communities. Aligns with clinical and payer

Fidelis Care will host four Provider Office Hours in July 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 – July 2026   Topic: Fidelis Care – Back to Basics When:  Thursday, July 9th – 1PM – 2PM EST Click here to register*   Topic: Fidelis Care and WellCare Quality Programs When:  Wednesday, July 15th – 10:00AM – 11:00AM EST Click

As you may be aware, Section 12006 of the 21st Century Cures Act, along with CMS guidance, required states to implement Electronic Visit Verification (EVV) for Personal Care Services by January 1, 2021, and for Home Health Care Services by January 1, 2023. As of 2026, EVV requirements are fully implemented, requiring applicable services to be electronically verified and documented, including the member receiving care, caregiver, service location, date, and type of service provided.   Next Steps To ensure EVV data is accurately captured for providers delivering in-scope EVV services, Fidelis Care will require all providers — including existing EDI and Enterprise (ENT)

Fidelis Care would like to inform providers of an important update from New York State regarding Child Health Plus (CHPlus) eligibility requirements. What’s Changing? Effective July 1, 2026, continuous eligibility beyond 12 months will no longer be permitted for children from birth through age six enrolled in Child Health Plus. This change aligns with federal guidance from the Centers for Medicare & Medicaid Services (CMS), which no longer allows states to approve or renew waivers that extend eligibility beyond 12 months for children in Medicaid or CHIP programs. What This Means for Members Beginning July 1, 2026: Children enrolled in CHPlus will be subject to