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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

Fidelis Care’s Pharmacy Services would like to provide clarification on how medications are covered under member’s medical and pharmacy benefits.   Medications Covered Under Fidelis Care Medical Benefit Physician Administered Drugs – medications administered to a member during the course of an outpatient visit Providers obtain medication via “buy-and-bill” or shipment to their practice site from a vendor of their choosing. Coverage is dictated by Fidelis Care Authorization Grids, Prior Authorization Lookup Tool and/or Evolent Specialty Services (formerly NCH) Authorization Grids (Oncology Regimen Specific). Medical Benefit Authorization Grids are plan specific. If a medication is listed on

Fidelis Care would like to inform providers of a new Fidelis Care Visit Attestation Form for ABA (Applied Behavioral Analysis), that is used for Applied Behavioral Analysis authorization reviews.   Please ensure your practice has the Fidelis Care Visit Attestation Form on file and includes it for any future Applied Behavioral Analysis authorization submissions to Fidelis Care.  The visit attestation form is available here on Fideliscare.org.   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 visit Contact Your Designated Provider Relations Specialist. Thank you for being