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Fidelis Care will host three Provider Office Hours in January 2025. During the webinar, Fidelis Care staff will be available to share information, provide an overview of provider resources, and answer your questions. Provider Office Hours – January 2025 Topic: Fidelis Care – Back to Basics When:  Thursday, January 9th – 9AM – 10AM EST Click here to register*   Topic: Claims and COB Overview When:  Thursday, January 23rd – 2PM – 3PM EST Click here to register*

Providers are required to maintain up-to-date demographic information to ensure efficient and timely processing of claims, accurate provider directory information, and appropriate contact information for communication.  As a reminder to our Fidelis Care providers, please review your demographic information in the Provider Portal on a regular basis to ensure the provider data is accurate.  If you have any questions regarding the Provider Portal, or would like to submit your demographic changes in another format (fax, email, or delegated roster), please contact your Fidelis Care Provider Relations Specialist.  To find your designated representative, please visit Contact Your Designated Provider Relations Specialist.  

Fidelis Care is pleased to inform you that the most recent 2024 QARR/HEDIS Care Gap 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 10/22/2024.  This report provides you with the opportunity to review preventative services for which Fidelis does not show your members as receiving in the measurement period.  We strongly suggest that you review the report for opportunities to either render the service, schedule the service to be done before 12/31/24 or if previously performed, submit supplemental data by 2/1/25.  Please notify

The following sections of the Fidelis Care authorization grids have been updated effective January 1, 2025.   The following codes have been updated on the Medicare, Medicaid, Essential Plan, and Metal-Level Products Authorization Grids and require prior authorization: III.       Outpatient surgery: The following services require prior authorization:                   D.  Skin surgery and other dermatological procedures: 15011, 15012               H.  Eyelid & ocular surgery: 66683                                                                                                                                   P. CAR-T Therapy: 38225, 38226, 38227, 38228                                                                                                                                 Q. Urology: 51721, 53865, 53866, 55881, 55882                                                                                                                                  R. Other: 60660, 60661                                                                                                                   V.        Outpatient and DME Services: The following services require prior authorization:               A.    Diagnostic testing     

As part of New York’s Medicaid Redesign Team (MRT) initiative, the NY 1115 Waiver introduced the Social Care Networks (SCN) Program, a transformative model focused on integrating social care into healthcare delivery. There is growing recognition that fully achieving health for all requires a focus not only on physical and behavioral health, but also on Health-Related Social Needs (HRSN). The SCN program encourages partnerships across health and social services to address Medicaid members' diverse needs, such as food insecurity, housing instability, and lack of transportation. Many of these HRSN services may become reimbursable to a member under the provision of