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The following section of the Fidelis Care authorization grids have been updated effective April 1, 2025.   The following codes have been added to the Medicare Authorization Grid and do not require prior authorization: B. Durable Medical Equipment: The following DME codes do not require an authorization: L3660, L3915   Visit:  Authorization Grids

Fidelis Care would like to remind providers of CMS correct coding guidelines to prevent billing errors and potential audits.  Fidelis Care has found instances where claims for the same service were billed multiple times using the same revenue code.  Per CMS guidelines, providers must ensure that each service charge has a distinct revenue code.   Reference Material Centers for Medicare & Medicaid Services (Chapter 1/ Subsection 120.3 - Suspect Duplicates, Page 261 and 263) - Click Here   If you have any questions, please contact your Fidelis Care Provider Engagement Account Manager. To find your designated representative, please visit Contact Your Designated Provider Relations Specialist.  

Fidelis Care is pleased to announce that a new Provider Bulletin is now available. The bulletin features updates on important initiatives and the latest news of interest to our provider community. Articles in this issue: Fidelis Care Provider Portal and Availity Essentials Transition Encourage Patients to Get Screened for Hepatitis C Family Planning and Reproductive Healthcare Prevent Lead Poisoning The Importance of Domestic Violence Screening    Please download Fidelis Care Provider Bulletin – Volume 11, Issue 1.   To view our Provider Bulletin Library, please visit: Provider Bulletins.

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 is committed to ensuring that our members have access to essential preventive services that promote overall well-being and enhance their quality of life. As a contracted provider with Fidelis Care, your role is vital in helping us achieve this commitment.   For over 25 years, Fidelis Care has provided incentive payments to participating providers for delivering routine preventive care and promoting health among members. The organization remains dedicated

Access to quality care is important to eliminate health disparities and increase the quality and years of healthy life for all New Yorkers. The NYSDOH requires that certain Access and Availability Standards be met by PCPs, OB/GYNs, specialists, and behavioral health providers where applicable. Click here to view the full list of standards, including situations and timeframes.   For additional questions, or if we can be of assistance in any way, please contact your Fidelis Care Provider Engagement Account Manager. To find your designated representative, please click here.