欢迎，纽约州医疗保健提供者！

Fidelis Care is pleased to announce that the new Quality Care Incentives (QCI) Program is now available on Provider Access Online. Once logged in, please navigate to the File Downloads section to access the brochure.   Fidelis Care is committed to ensuring that our members have access to essential preventive services that promote overall well-being and enhance their quality of life. As a contracted provider with Fidelis Care, your role is vital in helping us achieve this commitment.   For over 25 years, Fidelis Care has provided incentive payments to participating providers for delivering routine preventive care and promoting health among members. The organization remains dedicated

Access to quality care is important to eliminate health disparities and increase the quality and years of healthy life for all New Yorkers. The NYSDOH requires that certain Access and Availability Standards be met by PCPs, OB/GYNs, specialists, and behavioral health providers where applicable. Click here to view the full list of standards, including situations and timeframes.   For additional questions, or if we can be of assistance in any way, please contact your Fidelis Care Provider Engagement Account Manager. To find your designated representative, please click here. 

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