Provider Manual - Medicaid Managed Care, Child Health Plus, Medicare Advantage and Dual Advantage, Fully Integrated Duals Advantage (FIDA), Fidelis Care at Home (MLTC), and HealthierLife (HARP)

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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, Part 1 - Claim Submission
Section 12, Part 2 - Billing Guidelines
Section 12A - Affidavit Form
Section 12B - Corrected Claims Form
Section 13 - Provider Appeals
Section 13A - Provider Appeals Form
Section 14 - Member Grievances and Complaints
Section 15 - Retired
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 - Retired
Section 21 - Behavioral Health
Section 21A - Retired

Fidelis Care Products
Section 22A - Fidelis Medicare Advantage
Section 22B - Fidelis Care at Home
Section 22C - Medicaid Advantage Plus
Section 23 - Full Integrated Duals Advantage (FIDA)
Section 24 - HealthierLife - Health and Recovery Plan (HARP)

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 - New York State Prenatal Guidelines
Appendix IX - Clinical Guidelines - A Provider's Guide to Public Health Issues
Appendix X - Medicaid Member Handbook
Appendix XI - Retired
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
Appendix XVII - SNP/MOC Provider Training
Appendix XVIII - FIDA Grievances and Appeals
Appendix XIX - Cultural Sensitivity and ADA
Appendix XX - LHCSA Responsibilities and Operating Standards

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