The Fidelis Care Blog

As a reminder, participating providers may not under any circumstances bill a Fidelis Care member (except for copayments or coinsurance for applicable lines of business for any services rendered under an agreement with Fidelis Care) unless the provider has advised the member, prior to initiating service, that the service is not covered by Fidelis Care for that specific member's product line of business, and has obtained the member's written consent agreeing to personally pay for the service.

Copayments may be collected at the time of service. However, providers should not bill members for any cost-sharing amounts until after the Remittance Advice (RA) is received.

In addition, providers will not be reimbursed administrative fees for the following services provided to members:

• No Show/Missed Appointments: The federal Centers for Medicare and Medicaid Services (CMS) have prohibited state Medicaid programs from allowing providers to bill Medicaid enrollees for missed appointments.
• Medical Record Copy Fee: If it is a provider's practice to charge patients for copies of their medical records (private pay and third party insurance), providers may bill the Medicaid enrollee. Note: Sections 17 and 18 of the Public Health Law stipulate that the maximum amount that may be charged for paper copies of health records and/or patient information furnished pursuant to such sections may not exceed seventy-five cents per page.
• Form Completion Fee: New York Medicaid does not reimburse providers for the completion of forms (e.g., physicals). If it is your practice to charge all patients for completion of forms (private pay and third party insurance), you may bill the Medicaid enrollee.

If you have any questions, please contact your Fidelis Care Provider Relations Specialist, or call 1-888-FIDELIS (1-888-343-3547).