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Special Note for Western New York

Please use WNYHealtheNet to access Fidelis Care data if you are in the 8 counties of Western New York.
 
Fidelis Care Provider Request Form
Announcements
Fidelis Care Reduces Number of Services that Require Pre-Authorization
Fidelis Care will no longer require pre-authorization for chemotherapy administration, radiation therapy, dialysis, and most ambulatory surgery procedures with dates of service beginning April 1, 2008 that occur in the office, hospital outpatient or free standing surgical center.
Provider Portal Access Available Now.
Providers are now able to electronically request access to our secure provider portal by visiting fideliscare.org.
Quality Care Management Incentive Program
Fidelis Care Quality Care Management Incentive Program 2008
NPI Contingency Plan
Effective May 23, 2007, HIPAA covered transactions must use the mandated NPI. The use of NPI is required by HIPAA regulation; failure to do so will delay reimbursement. Covered entities who can demonstrate good faith effort are eligible to participate in a contingency plan.
National Provider Identifier: Know the facts and submit your information.
The NPI is the standard unique health identifier for health care providers. The NPI will replace the use of all legacy health care provider identifiers in standard transactions as of May 23, 2007.
Public Health Requirements and Recommendations
The Compendium of Public Health Requirements and Recommendations includes guidelines for the prevention, diagnosis, and management of diseases.
Fidelis Claims Editing Software
Fidelis utilizes TriZetto's Claims Editing Software to automatically review and edit health care claims submitted by physicians and facilities.
Electronic Claims Submission Expedites Reimbursement Process
Important News for Fidelis Care Providers
Options
Provider Manual
The answers to most questions can be found in our Provider Manual. Simply click on the appropriate topic to discover the information you need. Our manual also includes comprehensive information regarding our Child/Teen Health Program for those providers who are involved in pediatric care for Medicaid members under the age of 21.
Policy Updates
Periodically, Fidelis Care issues Policy Updates. Here you will find the latest changes, recommendations and guidelines regarding your Fidelis Care contract. If you cannot find an answer to your question or if you wish further clarification about a specific policy or procedure, please call our toll-free Provider Line at 1-888-FIDELIS (1-888-343-3547).
Fidelis Medicare Advantage Exceptions and Appeals
With Fidelis Medicare Advantage, you have the right to file a grievance if you have a complaint about Fidelis Medicare Advantage or one of our network pharmacies.
Quality Management
Presents issues regarding quality management, including the Quality Assurance Reporting Requirement of New York State, the Quality Incentive Program, and the BabyCare Incentive Program.
Newsletters
Articles on medicine, policy, services, referrals, billings, procedures, benefits, services, and Fidelis Care.
Provider Bulletin
The Provider Bulletin offers physicians and other healthcare providers the latest information on a variety of topics, including medicine, guidelines, policy and Fidelis Care.
Fidelis Formulary
The Fidelis Care Formulary.
Provider Education and Resources
Provider Education offers physicians and other healthcare providers articles, newsletters and the latest information on a variety of medical topics.
Provider Transportation Application
Fidelis Care New York Provider Transportation Application For Members