2024/2/28
• Posted by Provider Relations
• in
Provider News
The following sections of the Fidelis Care authorization grids have been updated effective April 1, 2024.
The following codes have been updated on the Medicare, Medicaid, Essential Plan, and Metal-Level Products Authorization Grids and require prior authorization:
H. Therapeutic Services:
1. Pain Management Codes (i.e. injections, TENS, therapeutic services): 20526, 20550, 20551, 20552, 20553, 21073, 27096, 62263-62264, 62273, 62280, 62281, 62282, 62290, 62320, 62321, 62322, 62323, 62324, 62325, 62326, 62327, 63622, 64400-64530, 64553-64595, 64600-64640, 64582, 64583, 64628, 64629
Note: 63622 does not require authorization for requests from
2024/2/27
• Posted by Provider Relations
• in
Provider News
你問，我們聽！ Fidelis Care 很高興地宣布提供者入口網站中的一項新功能，允許提供者以電子方式提交索賠爭議。 借助這項易於使用的新工具，提供者能夠提交 COB 重新提交、索賠上訴或索賠重新考慮。
2024/2/27
• Posted by Provider Relations
• in
Provider News
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's QCI Program rewards groups/practices for providing recommended preventive care, for caring for members with chronic disease, and for comprehensive obstetrical care. As your health plan partner, we remain committed to rewarding our providers for achieving high-quality outcomes, and have made significant changes to the program for measurement year 2024 to align with our shared goals, encourage participation, and recognize regional differences within New York State.
For
2024/2/22
• Posted by Provider Relations
• in
Provider News
Fidelis Care would like to inform providers of an upcoming change to the Comprehensive Psychiatric Emergency Program (CPEP) rate code 4009 for Crisis Outreach Service Visits. Effective July 1, 2024 rate code 4009 will be retired for Medicaid plans, including HIV Special Needs Plans (HIV SNPs), and Health and Recovery Plans (HARPs). With the announced State Plan Amendment (SPA) approval for Crisis Intervention services, CPEPs are allowed to bill utilizing the mobile crisis rate codes for both adults and children.
If you have any questions, please contact your Fidelis Care Provider Relations Specialist. To find your designated representative, please visit Contact Your Designated
2024/2/22
• Posted by Provider Relations
• in
Provider News
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:
Pharmacy Benefit Transition to Express Scripts
Access the New Prior Authorization Lookup Tool
PCP Requirement Underway for Essential Plan
Provider Surveys Drive Improvement at Fidelis Care
Sexually Transmitted Infections Treatment Guidelines
Please download Fidelis Care Provider Bulletin – Volume 10, Issue 1.
To view our Provider Bulletin Library, please visit: Provider Bulletins.