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Fidelis Care is pleased to announce that providers now have access the Availity Clinical Quality Validation (CQV) tool designed to help providers close care gaps quickly and accurately. Through the Availity Essentials portal, CQV streamlines documentation and improves quality scores while reducing administrative burden.   What is CQV? Clinical Quality Validation (CQV) is an Availity Essentials application that helps providers: ·         Monitor targeted care gaps/measures for the measurement year. ·         View and respond to payer requests for clinical/medical data. ·         Improve quality scores and reduce administrative burden.   Benefits ·         Streamlined workflow for care gap closure. ·         Faster access to clinical data. ·         Enhanced provider experience across multiple markets.   Availity-led Training for

Recent changes for the 2026 Health Insurance Marketplace may affect eligibility for members at health plans across the nation.  One important update is the way in which current and future Marketplace beneficiaries will apply for Advanced Premium Tax Credits (APTCs) in 2026 and beyond. That’s why Ambetter from Fidelis Care is sharing a quick reminder with our participating providers on the best way to confirm Member eligibility in the Availity Essentials platform and other secure portals.   Grace Periods for Members receiving an APTC Members enrolled in a Marketplace health plan are responsible for completing their premium payments each month. Members that do not

We want to inform you that we are currently experiencing high call volumes in our Provider Contact Center, which are impacting wait times. We understand the importance of timely support and appreciate your patience during this period.  Please consider using the Fidelis Care Provider Portal or Availity which offer convenient self-service options including but not limited to: claim status, authorization status and member eligibility. We will provide updates when available. Thank you for your understanding and continued partnership. If you have any questions, please contact your Fidelis Care Provider Engagement Account Manager. To find your designated representative, please click here.  Fidelis Care is proud to be

Special Supplemental Benefits for the Chronically Ill (SSBCI) can be offered to Medicare Advantage (MA) members who have one or more complex chronic conditions, are at high risk for hospitalization or adverse health outcomes and require intensive care coordination. SSBCI aims to improve overall health outcomes for the chronically ill population by addressing social needs beyond traditional medical care such as food, housing, transportation, and gaps in care. The program is designed to support individuals by offering additional services beyond standard Medicare coverage. Members must qualify for SSBCI benefits Members must meet all three criteria to qualify: The member must require intensive

As you know, Fidelis Care relies upon the receipt of membership information from the New York State Department of Health (SDOH) prior to issuing capitation payments. The date for receiving this information from the SDOH varies from month to month. In certain months, the availability of data may be delayed as much as one week. Nevertheless, Fidelis Care has historically made capitation payments as close to the first of each calendar month as possible.    Presented below is Fidelis Care’s 2026 capitation check and Electronic Funds Transfer (EFT) schedule. Please refer to this to determine the timing of your monthly payment.  Over