Provider Manual - Medicare, Medicaid, Family Health Plus, Child Health Plus and Managed Long Term Care

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Section 1 - Introduction to Fidelis Care New York
Section 2 - Member Rights
Section 3 - The Provider's Roles and Responsibilities
Section 4 - Primary Care Services
Section 5 - Specialty Provider Services
Section 6 - Women's Health Provider Responsibilities
Section 7 - Standards for Medical Record Documentation
Section 8 - Emergency and Inpatient Services
Section 9 - Provider Credentialing and Termination
Section 10 - Health Care Performance Evaluation
Section 11 - Referral and Pre-Authorization
Section 12 - Billing and Claims
Section 12A - Request for Administrative Review
Section 12B - Affidavit Form
Section 12C - Corrected Claim Form
Section 13 - Provider Appeals
Section 14 - Member Grievances and Complaints
Section 15 - Intentionally left blank
Section 16 - Family Planning
Section 17 - Enrollment and Eligibility
Section 18 - Product Information
Section 18A - Personal Care Services
Section 19 - Authorizations for Non-Participating Providers
Section 20 - FHP Co-Payment
Section 21 - Behavioral Health
Section 21A - Outpatient Treatment Report

Senior Services
Section 22A - Fidelis Medicare Advantage
Section 22B - Fidelis Care at Home
Section 22C - Medicaid Advantage Plus

Appendix I - Authorization Grid
Appendix II - Pharmacy Services
Appendix III - Vaccines for CHP, FHP, and NYM members
Appendix IV - CAGE A Instrument
Appendix V - Depression Screen: Patient Health Questionnaire (PHQ-9) and Scoring Instructions for PHQ-9
Appendix VI - HIV Names Reporting and Partner Notification Regulations
Appendix VII - New York State Child/Teen Health Program
Appendix VIII - Intentionally left blank
Appendix IX - Clinical Guidelines
Appendix X - Medicaid Member Handbook
Appendix XI - FHP Member Handbook
Appendix XII - CHP Member Handbook
Appendix XIII - Sample ID Cards
Appendix XIV - Guide to Billing for OB Providers
Appendix XV - Bill Above
Appendix XVI - Special Needs Plan

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