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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 7/16/2024.  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 supplemental data by 2/1/25.  Please notify

Fidelis Care will host two Provider Office Hours in September 2024. During the webinars, Fidelis Care staff will be available to share information, explain different resources, and answer your questions. Provider Office Hours – September 2024   Topic: Back to Basics – Doing Business with Fidelis Care When:  Thursday, September 11th – 12PM – 1PM EST Click here to register*     Topic: Fidelis Care Tools & Resources Overview When:  Thursday, September 26th – 2PM – 3PM EST

As a Fidelis Care network provider, you may find yourself in a position to provide trauma-informed care to Medicaid Managed Care (MMC) enrolled children/youth in direct placement foster care and in the care of Voluntary Foster Care Agencies (VFCAs).   Provision and coordination of services for children/youth in foster care, must be done in compliance with the New York Medicaid Program 29-I Health Facility Billing Manual and the Transition of Children Placed in Foster Care and NYS Public Health Law Article 29-I Health Facility Services  into Medicaid Managed Care guidance documents located at: https://www.health.ny.gov/health_care/medicaid/redesign/behavioral_health/children/vol_foster_trans.htm.   The pharmacy benefit requirements include, but are not limited to,

Please join the Clinical Documentation Improvement team, as they present on the HCC Model Changes V24 vs V28. These webinars will provide information to support proper coding, documentation of coding, and documentation of patient risk factors. These webinars will also provide a high-level overview of CMS Model Changes.   Please note: This webinar series is different than the webinars that were presented in January 2024. This new series does a deep dive into how the changes affect different diseases found in the HCC Model Changes.    To register, please click on the link next to the webinar you would like to attend.   CMS Model Updates Webinars

The following sections of the Fidelis Care authorization grids have been updated effective October 1, 2024.   The following has been added to the Medicare, Medicaid, Essential Plan, and Ambetter By Fidelis Care Metal-Level Products Authorization Grids and requires prior authorization:   Behavioral Health - Outpatient services: Transcranial Magnetic Stimulation (TMS) - Covered; Authorization Required for CPT Codes 90867, 90868 and 90869            Requests for members can be made by email qhcmbh@fideliscare.org, fax (833-561-0098) or by calling 1-888-FIDELIS (1-888-343-3547) and following the prompts for Behavioral Health, or dialing extension 16072.                                 Members over 18 years old may be eligible for this service when TMS is administered using an FDA-cleared