Welcome, Brokers!

Fidelis Care would like to remind providers of the updated calculation of hospitals’ initial inpatient acute, exempt hospital, and exempt unit reimbursement rates for Medicaid Fee-for-Service (FFS) and Medicaid Managed Care (MMC), which were effective October 1, 2024.   As per Medicaid DOH site, an administrative letter was published to support reduction to the capital rate add-ons. Providers should have received notification from the State regarding this rate update.    The October 1, 2024 Medicaid FFS rates have been approved by the New York State Division of the Budget (Budget) and have been transmitted to eMedNY for payment and retroactive claims processing.   These rates are

Fidelis Care would like to notify providers that the MCG Cite Guideline Transparency Tool was upgraded to the 29th edition effective Saturday, April 26, 2025. Providers can access this tool through the Fidelis Care Provider Portal. Highlights of the changes in the 29th edition of the MCG care guidelines include: Five new observation care guidelines in MCG Inpatient & Surgical Care to support the use of observation care for specific diagnoses. In addition, a new calculator for mean arterial pressure (MAP) was added to the content (where applicable). A new “Gene and Cellular Therapy” section containing guidelines for cutting-edge treatments was added

Annual cultural competency training for participating providers is required by the New York State Department of Health.  At this time, The New York State DOH will only accept the approved training offered by the United States Department of Health and Human Services (HHS), Office of Minority Health education program, Think Cultural Health, to fulfill the requirement for provider annual cultural competency training.*   Once the cultural competency training has been completed, providers need to verify completion of the program by emailing the Cultural Competency Attestation Form to: CulturalCompetencyTrainingAttestation@fideliscare.org.   The required Cultural Competency Training needs to be completed annually by December 31st. Providers that completed

Effective May 1, 2025, the provision of School-Based Health Center (SBHC) and SBHC-Dental (SBHC-D) services will be incorporated into the Mainstream Medicaid Managed Care (MMC) and HIV Special Needs Plan (HIV SNP) benefit package. Therefore, Fidelis Care will be responsible for reimbursing SBHC operators for SBHC services provided to Fidelis Care members. The goal of the transition is to maintain access to these critical SBHC and SBHC-D services while integrating the services into the larger health care delivery system. It is anticipated that the integration of SBHC and SBHC-D services within the existing managed care framework, and coordination of services with

In an effort to streamline provider demographic changes and provider termination requests, Fidelis Care has created two new electronic forms for providers to use.  Please use these forms to submit changes under a singular TIN. In order to expedite the request, all fields on the forms are required. If not complete, the request will be delayed. Forms available on fideliscare.org: Provider Demographic Change Request Form   Provider Termination Request Form   Once completed, the forms can be submitted electronically to SMProviderAttestationUpdates@fideliscare.org. In the subject line of the email, please enter Demographic Change/Termination Request for "Your Provider/Group Name" in "Your County" (i.e. Demographic Change Request