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The following sections of the Fidelis Care authorization grids have been updated effective February 1, 2024.   The following code has been added to the Medicaid DME Authorization Grid and requires prior authorization: L5781  Addition to lower limb prosthesis, vacuum pump, residual limb volume management and moisture evacuation system                                    The following codes have been removed from the Medicaid DME Authorization Grid and do not require prior authorization: V2625  Enlargement of Eye Prosthesis V2626  Reduction of Eye Prosthesis                        The following code has been updated on the Medicaid, Essential Plan, and Metal-Level Products Authorization Grids and requires prior authorization:                                    J2781  pegcetacoplan inj (Syfovre)   The following code has been added to the

Fidelis Care would like to remind providers that COVID-19 vaccinations for children under the age of 19 covered under Child Health Plus and Medicaid Managed Care are available through the federal Vaccine for Children (VFC) program. There are various options for children to obtain the vaccine through a VFC provider.  These options include: Provider’s Office Public Health Clinic County Health Department Local Pharmacy Enrolled in NY Medicaid and VFC   There is no out-of-pocket cost for this vaccination under the VFC program. COVID-19 vaccine billing guidance for this season is available here. The NY Medicaid Pharmacists as Immunizers Fact Sheet has information on how to

Fidelis Care has partnered with MCG Health to implement the MCG Cite Guideline Transparency Tool. Effective January 1, 2024, you can access this feature through the Fidelis Care Provider Portal. With the MCG Cite Guideline Transparency Tool, Fidelis Care can share clinical indications with providers. The tool is a secure resource that helps meet regulations around transparency for care delivery. Benefits include: Transparency: Delivers industry-leading medical determination transparency. Access: Allows the review of MCG clinical evidence used by payers to support         member care decisions. Security: Ensures easy and flexible access via secure web access. This Quick Reference Guide details how

Fidelis Care is aware that a small number of Essential Plan members may have received incorrect ID cards with January 1, 2024 effective dates. Any members identified as needing corrected ID cards have been notified of the issue and will receive new ID cards no later than December 31, 2023.  Prior to December 31, 2023, if providers are presented with an Essential Plan ID card with a January 1, 2024 effective date, providers are encouraged to confirm the member’s eligibility through our Provider Portal or by calling our Provider Call Center at 1-888-FIDELIS (1-888-343-3547), TTY: 711.

Fidelis Care will host two unique Provider Office Hours in January 2024. During the interactive Zoom sessions, Fidelis Care staff will be available to share information, explain different resources, and answer your questions. Provider Office Hours – January 2024 Topic: Back to Basics – Doing Business with Fidelis Care When:  Tuesday, January 9th - 1 PM - 2PM Click here to register   Topic: Claims Overview When:  Thursday, January 25th - 3PM - 4PM Click here to register