Fidelis Care is proud to work with a network of more than 53,000 primary care physicians, specialists, hospitals, and health care professionals across New York State to provide our members with the highest quality care and service.
Fidelis is pleased to announce that the following Core Mandated Requirements have been implemented
- CAQH CORE 350: Health Care Claim Payment/Advice (835) Infrastructure Rule
- CAQH CORE 360: Uniform Use of CARCs and RARCs (835) Rule
- CAQH CORE 370: EFT & ERA Reassociation (CCD+/835) Rule
- CAQH CORE 380: EFT Enrollment Data Rule
- CAQH CORE 382: ERA Enrollment Data Rule
Non-Emergency Transportation Benefit Update
As part of a Medicaid Redesign Team initiative, under the New York State Department of Health, the non-emergency medical transportation benefit (NEMT) for Medicaid members is phasing out of the managed care benefit package in Monroe County effective January 1, 2014.
Medicaid and Family Health Plus Benefits Update - Effective November 1, 2013
Important changes in effect for Medicaid and Family Health Plus (FHP) coverage which will impact the following services:
- Implantable Infusion Pump for Opioid Administration for Purposes of Pain Management
- Transcutaneous Electrical Nerve Stimulation (TENS)
- Functional Electrical Stimulation (FES)
For more information, please refer to the September 2013 Medicaid Update - http://www.health.ny.gov/health_care/medicaid/program/update/2013/2013-09.htm
The Second Update to the 2013 QCMI Brochure is Now Available
Fidelis Care is pleased to announce that a second updated 2013 QCMI Brochure is now available on Provider Access Online. The update was made based upon New York State Department of Health retiring the Appropriate Asthma Medications - 3 or more Controller Dispensing Events measure for measurement year 2013.
Fidelis Care has replaced that measure with Medication Management for People with Asthma - 50% Compliance. Please see page 7 of the brochure for more information.
The 85th percentile thresholds have also been updated with the release of eQARR 2013 (for measurement year 2012). The thresholds can be found on page 11 of the brochure.
Important Notice for Primary Care Providers
Information about the payment methodology for the Primary Care Rate Increase ( PCRI) for providers who qualify under the Affordable Care Act and have filed attestations with Computer Sciences Corp may be found at https://portal.fideliscare.org/provider/. Please note that payments are not expected to be made until November or December of 2013.
Fidelis Care Formulary Update 10/1/2013
Fidelis Care has updated its formulary effective 10/1/13. Please see attached summary for details of the changes
Fidelis Care releases updated information and FAQ on the New York State of Health: The Official Health Plan Marketplace
As part of the federal Patient Protection and Affordable Care Act (ACA), New York's Health Benefit Exchange--the New York State of Health--has started its open enrollment period, with coverage to begin on January 1, 2014.
Modification of behavioral health authorization requirements
Fidelis Care is pleased to announce changes in the authorization requirements for outpatient behavioral health (BH) services that will significantly simplify and streamline the process for providers and members.
Effective for dates of service on or after September 1, 2013, authorizations will no longer be required for most outpatient behavioral health (mental health and substance abuse) services and behavioral health professional home care visits provided by participating providers.
All BH services provided by non-participating providers will continue to require authorization.
These changes apply to all products offered by Fidelis Care.
Please see the Fidelis Care Authorization Requirements Grids for Medicaid /Family Health Plus /Child Health Plus and Medicare for full details of these changes, including a list of those outpatient BH services that will continue to require authorization.
Medicaid Benefits Update - August 1, 2013
Effective August 1, 2013, Fidelis Care will assume responsibility for Case Management and reimbursement for the following services previously managed by Medicaid Fee for Service.
- Directly Observed Therapy for Tuberculosis Disease
- Adult Day Health Care
- AIDS Adult Day Health Care
This benefit applies to Fidelis Medicaid Managed Care Members. For more information call the Fidelis Provider Call Center at 1-888-FIDELIS (1-888-343-3547).
Please click here to read the Medicaid Update Newsletter-July 2013 for more information on these benefits.
Fidelis Care has updated the Authorization Grids for Medicare, Medicaid, Family Health Plus, and Child Health Plus programs. These changes are effective September 1, 2013 and include Adult Day Health Care and AIDS Adult Day Health Care for the Medicaid line of business.