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Fidelis Care is introducing the Apex 80 Award for eligible providers who ensure members receive timely preventive care in 2026. The program focuses on Annual Preventive Visits, which give primary care providers (PCPs) an important opportunity to assess a member’s overall health, address care gaps, and identify medical needs before they become serious. Eligible PCPs who serve Fidelis Care fee-for-service Medicaid enrollees will receive an incentive payment when at least 80% of their Fidelis Care member panel completes an Annual Preventive Visit in 2026. The Apex 80 Award supports Fidelis Care’s continued collaboration with providers to advance quality outcomes and improve access to

Every August, communities across the nation recognize Overdose Awareness Month, an opportunity to raise awareness about substance use disorders (SUD), reduce stigma, remember lives lost to overdose, and connect individuals to life-saving treatment and support services. Overdose prevention is a shared responsibility, and healthcare providers play a critical role in identifying individuals at risk, providing education, and facilitating access to care.   The Importance of Provider Engagement Healthcare professionals are often among the first to recognize signs of a substance use disorder. Early intervention, compassionate conversations, and timely referrals can help individuals access treatment before a crisis occurs. Providers can also help normalize

Managing authorization follow-ups just got easier with request for additional information (RFAI). You can securely receive and respond to requests from Fidelis Care — right within Availity Essentials.   Key benefits No calls or faxes — manage authorizations online. Keep requests moving — respond quickly with supporting clinical documentation. Track activity in one place — monitor and manage requests from a single dashboard.   View and respond to RFAIs Use the Authorization/Referral Dashboard to review and respond to requests for additional information. On the Dashboard Summary page, look for Pending Action – Contact Payer in the Status/Last Updated column. Open the authorization and review the

The following section of the Fidelis Care authorization grids has been updated effective September 1, 2026.             The following section of the Medicaid, CHP, Essential Plan, Ambetter Metal-Level Plans, and Medicare Authorization Grids and requires prior authorization: III.       Outpatient surgery: The following services require prior authorization:                                 D.  Skin surgery and other dermatological procedures: Q4110, Q4111           The following codes have been added to the Medicaid, CHP, Essential Plan, Ambetter Metal-Level Plans, and Medicare Authorization Grids and require prior authorization: J0528 fosfomycin disodium J2374 apraclonidine hcl J7176 fibrinogen-chmt (Fesilty)   Visit:  Authorization Grids

Effective September 1, 2026, Fidelis Care will implement the Leveling of Care: Emergency Department Evaluation and Management (E/M) Overcoding for Facility Services Policy (CC.PP.80) for applicable lines of business. This policy is designed to help ensure facility Emergency Department E/M coding accurately reflects the level of resources used during a patient visit. Claims will go through a review prior to payment to determine if the billed level of service is supported by the claim evidence and resources.  This approach is consistent with national billing guidance and industry oversight priorities. Both the Centers for Medicare & Medicaid Services (CMS) and the Office of