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Fidelis Care would like to inform providers of updated requirements with the NYS Recipient Restriction Program. The goal of the Recipient Restriction Program (RRP) is to coordinate medical and/or pharmacy services and improve the quality of care for Medicaid recipients. Coordination of care reduces the potential over-utilization of health care services, prevents abusive or fraudulent behavior, and protects Medicaid recipients’ health and safety.   As of February 24, 2025, a restricted recipient must comply with the Recipient Restriction Program. If restricted to a pharmacy, the restricted recipient will be required to fill prescriptions at their designated pharmacy. Claims will not pay if

Fidelis Care will host three Provider Office Hours in April 2025. During the webinars, Fidelis Care staff will be available to share information, provide an overview of provider resources, and answer your questions. Provider Office Hours – April 2025 Topic: Fidelis Care – Back to Basics When:  Thursday, April 10th – 12PM – 1PM EST Click here to register*   Topic: Fidelis Care - Credentialing and Data Maintenance Overview When:  Thursday, April 24th – 2PM – 3PM EST Click here

Doctors play an important role in keeping people healthy. They provide expert care, guidance, and compassion to patients every day. In honor of National Doctors’ Day, Fidelis Care thanks doctors everywhere who make a difference in our communities. We visited with doctors from provider partners Compassionate Family Medicine in Syracuse, Polaris Healthcare Visiting Docs in Spring Valley, and WNY Medical in Buffalo to get their thoughts in observance of National Doctors’ Day.   Fidelis Care: What inspired you to become a doctor?   Dr. Riffat Sadiq, WNY Medical: From a young age, I enjoyed helping people to take care of themselves. I had my

The following section of the Fidelis Care authorization grids have been updated effective May 1, 2025.   The following codes have been updated on the Medicare, Medicaid, Essential Plan, and Ambetter Metal-Level Products Authorization Grids and require prior authorization: III.       Outpatient surgery: The following services require prior authorization:            D.  Skin surgery and other dermatological procedures: 11730  requires an authorization when billed with REV codes 0360, 0361 and 0490 Only the following codes require authorization for any place of service: A2030, A2031, A2032, A2033, A2034, A2035, 11200, 11201, 11719, 15769 - 15829, 17340-17999, Q4354, Q4355, Q4356, Q4357, Q4358, Q4359, Q4360, Q4361, Q4362, Q4363, Q4364,

Fidelis Care would like to alert providers of an important change to the NYRx Pharmacy Program’s coverage, effective 04/01/2025.   Changes to Over-the-Counter Medications:  Beginning 04/01/2025, per the Commissioner’s recommendation, NYRx will no longer cover the following over-the-counter items: • Oxymetazoline containing OTC products (Afrin®) • Phenylephrine-containing OTC products (Sudafed PE®)* • Simethicone-containing OTC products (Gas-X) • Glucose tablets • Bacitracin-containing OTC products • Neomycin-containing OTC products • Multivitamins for members 21 and older** *This does not include pseudoephedrine (Sudafed®) containing products, which will continue to be covered. **This does not include prescription-only prenatal vitamins, which will continue to be covered.    How this may impact our membership: If members were filling

Fidelis Care’s Pharmacy Services would like to provide a reminder and clarity on how to submit claims for medications billed under the member’s medical benefit, as well as the appropriate Servicing Provider to document when submitting a Pharmacy Prior Authorization request for such medications. A Pharmacy Prior Authorization Request form can be found on the Fidelis Care website within the Utilization Management Programs section.   Documenting the Appropriate Serving Provider When submitting a Pharmacy Prior Authorization, the Servicing Provider should be the individual provider, facility, or pharmacy who will be supplying and subsequently billing for the supply of the requested medication.  This should be