Welcome, Brokers!

The following sections of the Fidelis Care authorization grids have been updated effective August 1, 2024.   The following code has been added on the DME Authorization Grid: E1815  Dynamic adjustable ankle extension/flexion device, includes soft interface material   Evolent Oncology Program (New Century Health) will require review of the following codes for Medicaid, Medicare, Essential Plans and Metal-Level Products: J8999    iptacopan oral J8999    tovorafenib oral J8999    tovorafenib oral suspension J9999    docetaxel (Docivyx) J9999    tarlatamab J9999    trastuzumab-strf injection   Evolent Oncology Program (New Century Health) will require review of the following codes for Medicaid, Essential Plans and Metal-Level Products: J9393    fulvestrant (Teva)   Evolent Oncology Program (New Century Health) will require review of the following codes

Fidelis Care is implementing changes to our Peer-to-Peer process.   Due to CMS regulations, Fidelis Care is introducing a new Medicare procedure, effective immediately. We will no longer provide a Post-Decision Peer-to-Peer review for services pertaining to Medicare members. It is important to note that submitting a formal appeal will be necessary for any post-decision reviews.   For all other lines of business, Fidelis Care will continue to offer Peer-to-Peer reviews, which may result in a reversal of the initial decision based on the information provided as part of the Peer-to-Peer review. It is important to note that all Peer-to-Peer requests must be submitted

Fidelis Care will host two Provider Office Hours in July 2024. During the webinar, Fidelis Care staff will be available to share information, explain different resources, and answer your questions. Provider Office Hours – July 2024 Topic: Back to Basics – Doing Business with Fidelis Care When:  Thursday, July 11th – 12PM – 1PM EST Click here to register*   Topic: Fidelis Care Quality Programs When:  Thursday, July 25th – 2PM – 3PM EST Click here to register*

Effective July 1, 2024, Children’s Waiver Home and Community Based Services of Environmental/Vehicle Modifications and Assisted and Adaptive Technology will transition out of Medicaid Managed Care and be paid through Fee-for-Service. The review, payment, and approval of all NEW Children’s Waiver Environmental/Vehicle Modifications and Assisted and Adaptive Technology for children and youth enrolled in a Medicaid Managed Care Plan (MMCP) will be managed by the Children’s Health Home of Upstate NY (CHHUNY), who will serve as the designated Financial Management Service (FMS) provider, in conjunction with the New York State Department of Health (NYS DOH).   For additional questions, or if we

Fidelis Care has partnered with Pomelo Care to provide free 24/7 online pregnancy and infant care to eligible Medicaid Managed Care, HealthierLife (HARP), Essential Plan, and Ambetter from Fidelis Care Qualified Health Plan members. Effective June 1, 2024, Pomelo Care is available in the following counties: Bronx, Chautauqua, Erie, Greene, Lewis, Niagara, Putnam, Seneca, Steuben, Suffolk, Warren, and Westchester. Pomelo Care is a program available at no additional cost to eligible Fidelis Care members who are pregnant or had a baby within the last three months. Pomelo provides 24/7 pregnancy and infant care via SMS, phone, or virtual visits.   Pomelo Care’s Services: