Welcome, Brokers!

Fidelis Care is pleased to inform you that the most recent 2024 QARR/HEDIS Care Gap Report has been posted on Provider Access Online (provider portal). This information is indicative of all encounter data on file with Fidelis Care as of 12/10/2024.  This report provides you with the opportunity to review preventative services for which Fidelis does not show your members as receiving in the measurement period.  We strongly suggest that you review the report for opportunities to either render the service, schedule the service to be done before 12/31/24 or if previously performed, submit medical record supplemental data by 2/1/25. 

Beginning March 1, 2025, all Fidelis Care providers inquiring about authorization requirements will need to use the Authorization Grids and the Authorization Requirement Lookup Tool available on fideliscare.org. The Authorization Requirement Lookup tool will help providers determine which procedure codes require pre-authorization for Medicaid (including Child Health Plus and HARP products), Medicare, Essential Plans, and Qualified Health Plans (Ambetter from Fidelis Care).  Authorization requirements will no longer be available by contacting the Call Center.    Streamlined Access for Providers: Access the lookup tool on fideliscare.org: Navigate to Providers Under Provider Resources, find Authorization Resources then Authorization Grids Click on the Medicaid, Child

Fidelis Care will host four Provider Office Hours in February 2025. During the webinar, Fidelis Care staff will be available to share information, provide an overview of provider resources, and answer your questions. Provider Office Hours – February 2025   Topic: Fidelis Care – Back to Basics When:  Thursday, February 13th – 12PM – 1PM EST Click here to register*   Topic: Fidelis Care and Wellcare Quality Programs When:  Wednesday, February 19th – 10AM – 11AM EST Click

The following codes have been removed from the Medicaid and  Essential Plan Authorization Grids and do not require prior authorization: J0739 cabotegravir inj  J0741 cabotegrvir and rilpivirine inj  J0750 emtricitabine tenofovir df, oral for PReP  J0751 emtricitabine tenofovir alafenamide, oral for PReP  J0799 unclassified FDA approved PReP drugs  J1746 ibalizumab-uiyk (Trogarzo)  J1961 lenacapavir (Sunlenca)  Q0521 Pharmacy supplying fee for HIV pre-exposure prophylaxis FDA approved prescription S0104 zidovudine oral  S0140 saquinavir oral    Visit:  Authorization Grids

Fidelis Care would like to inform providers that doula services will be included in the benefit package for Medicaid Managed Care, HIV Special Needs Plan, and Health and Recovery Plan members effective April 1, 2025.  Doula services can include up to eight (8) visits by a doula during and after pregnancy and continuous support during labor and childbirth.  If a member becomes pregnant within 12 months following a prior pregnancy, the eligibility for doula services will start over with the new pregnancy.  Any unused doula services from the prior pregnancy will not carry over.   Perinatal Visits Up to eight (8) perinatal