Welcome, Brokers!

Beginning Nov. 18, you can validate eligibility and benefits, submit claims, check claim status, submit authorizations, and access Fidelis Care payer resources via Availity Essentials. Availity experts are hosting several live webinar sessions to help you get ready. Here’s a look ahead at what tools and functionality are coming, paired with live training to learn more. Space is limited, save your seat today!   Availity Essentials Introduction Monday, Nov. 18 – 3 p.m. EST Monday, Dec. 2 – 2 p.m. EST Authorization Tools Tuesday, Nov. 19 – 2 p.m. EST Tuesday, Dec. 3

As you may know, the United States is experiencing an IV fluid shortage after Hurricane Helene.  Fidelis Care would like to provide guidance regarding prior authorization (PA) requests that may be affected by this shortage.   Medications for use in Non-Oncology Diagnoses (PA Requests Submitted Directly to Fidelis Care Pharmacy) Fidelis Care is aware of the IV Fluid supply chain issues and has processes in place to consider the impacts of the IV Fluid shortages when reviewing medication Prior Authorization (PA) requests, for as long as the shortage is in effect. Providers must include communication and/or documentation that the medication Prior Authorization

Fidelis Care would like to inform our providers of plan changes that will be effective January 1, 2025.      Wellcare By Fidelis Care   Wellcare Fidelis Dual Plus (HMO D-SNP) - Plan 008 Effective January 1, 2025, Fidelis Care members currently in this plan will be enrolled in Wellcare Fidelis Dual Plus (HMO D-SNP) – Plan 003, unless the member chooses another plan.  

Effective January 1, 2025, Social Adult Day Care (SADC) transportation will remain a covered benefit under MLTC Plans and SADCs will no longer have the option of their transportation being carved out to fee-for-service. All SADCs will be responsible for managing their own transportation. SADC Programs can opt to use their own vehicles or contract directly with transportation vendors to secure transportation of SADC members to SADC programs. Before January 1, 2025, SADCs must transition any members whose trips to and from the SADC are arranged through their contracted MLTCP, MAP plan or through MAS to having their trips arranged and

Fidelis Care would like to inform providers of a federal amendment to the Consolidated Appropriations Act, 2023, that requires states to provide 12-months of continuous eligibility (CE) for children enrolled in Child Health Plus (CHP) plans and under the age of 19.   While New York currently has 12-months of continuous coverage in CHP, it has state specific exceptions which are no longer permitted under federal requirements. A child can only be terminated during the 12-month CE period due to one of the following exceptions: 1. The child reaches the age of 19; 2. The child or parent/guardian requests voluntary disenrollment from the program; 3.