2026/4/29
• Posted by Provider Relations
The following section of the Fidelis Care authorization grids has been updated effective June 1, 2026.
The following code has updated been on the Medicaid, CHP, Essential Plan, and Ambetter Metal-Level Plans Authorization Grids and requires prior authorization:
Q5111 pegfilgrastim-cbqv (udenyca)
Visit: Authorization Grids
2026/4/28
• Posted by Provider Relations
Fidelis Care would like to inform providers that we are unable to accept calls from Artificial Intelligence (AI) entities or other automated systems to verify claim status, obtain remittance information, or respond to any other inquiries. Fidelis Care representatives may only engage with a live person to verify PHI and ensure HIPAA compliance.
Providers are also encouraged to use the Fidelis Care Provider Portal to obtain needed information. For more information on the Provider Portal, please visit: https://www.fideliscare.org/Provider/Provider-Access-Online-Resources
For additional questions, or if we can be of assistance in any way, please contact your Fidelis Care Provider Engagement Account Manager. To identify your
2026/4/27
• Posted by Provider Relations
Fidelis Care has received notice from the Office of the Medicaid Inspector General (OMIG) of new compliance program requirements for Medicaid participating providers.
Effective April 2020, for New York State (NYS) Social Services Law (SSL) §363-d, and effective December 28, 2022, for the corresponding regulations at 18 New York Codes, Rules and Regulations (NYCRR) Subpart 521-1, NYS Medicaid providers shall adopt, implement, and maintain effective compliance programs aimed at detecting fraud, waste, and abuse in the NYS Medicaid program.
Who is Required to Have a Compliance Program?
NYS Social Services Law (SOS) § 363-d and Title 18 of the New York Codes, Rules
2026/4/23
• Posted by Provider Relations
Fidelis Care is continuing efforts to ensure compliance with Electronic Visit Verification (EVV) requirements under the 21st Century Cures Act. As part of this work, Fidelis Care has partnered with HHAeXchange (HHAX), a home care management solutions vendor. Providers may choose to use HHAX to submit claims; however, the system must be used for EVV. Claims associated with visits that do not have validated EVV may be denied or subject to recovery.
What Providers Need to Know
HHAX must be used for EVV validation, even if claims are submitted through another method.
Visits without validated EVV may result in claim denials
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