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HomeMemberHelpful ToolsHealth ResourcesHeart Disease

Heart Disease Resources

People of all ages need to keep their heart healthy. Eating well, exercising regularly, and seeing your health care provider can help you keep your heart healthy. Work with your healthcare provider and adopt good lifestyle habits to help lower the risk of heart disease.

Heart disease describes conditions related to plaque building up in the walls of the arteries. Other conditions include arrhythmia (abnormal heart rhythms), congenital heart failure, and heart valve problems.

What is your risk?

Heart disease can happen to anyone, including children. You can be born with it, and a family history of heart disease may increase your risk.

Most heart disease develops over time due to poor habits such as smoking or eating an unhealthy diet. Having high cholesterol, high blood pressure, or diabetes also increases your risk of heart disease. Talk with your provider about ways to prevent or manage diabetes and control other risk factors.

What is a good resting heart rate?

A normal resting heart rate for adults ranges from 60 to 100 beats per minute (bpm). Remember, factors such as age, physical activity, and overall health can affect what is considered your normal resting heart rate.

Talk to your provider if you have concerns about your heart rate.

How does high blood pressure affect heart health?

The higher your blood pressure levels, the more risk you have for heart disease, heart attack, and stroke. Causes for high blood pressure include:

  • Diabetes
  • Being overweight or obese
  • Smoking
  • Not getting enough regular physical activity
  • Unhealthy diets, including high amounts of sodium and alcohol

Talk to your provider about how you can lower your blood pressure to help avoid heart disease and stroke.

How can you lower your risk of heart disease?
• Eat plenty of fruits, vegetables, whole grains, nuts, poultry, and fish; avoid having too much salt or sugar
• Maintain a healthy weight
• Exercise at least 150 minutes per week
• Keep your blood pressure, cholesterol, and blood sugar at a healthy level
• Don’t smoke or use any tobacco products
• Follow your doctor’s recommendations
Can heart disease be treated?
Yes. Talk to your provider about how to safely reduce the risk of heart disease. You can also talk about setting goals for a healthier heart. Your provider may also prescribe medication.
What are symptoms of a heart attack?

A heart attack occurs when the flow of blood to the heart is severely reduced or blocked. Be aware of the following symptoms:

  • Fatigue
  • Cold sweat
  • Nausea
  • Chest pain
  • Dizziness
  • Shortness of breath
  • Pain in the jaw, neck, arms, shoulder, or back

Call 911 if you or someone you know is having a heart attack.

What can cause Congestive Heart Failure?

Congestive heart failure (CHF) is a chronic condition that makes it harder for your heart to pump blood and meet your body's needs. The following factors may increase your risk of CHF:

  • Diabetes
  • High cholesterol levels
  • High blood pressure
  • Poor diet
  • Not getting enough physical activity
  • Smoking and/or using tobacco
  • Being overweight or obese
  • Stress

Talk to your provider to learn more about CHF.

What can cause heart arrhythmia?

A heart arrhythmia is an irregular heartbeat. Factors that may cause arrhythmia include:

  • Blood sugar levels that are too low or too high
  • Caffeine, illegal drugs, and certain medications
  • Dehydration
  • Low levels of electrolytes, such as potassium, magnesium, or calcium
  • Physical activity
  • Strong emotional stress or anxiety
  • Vomiting or coughing
  • Smoke
  • Use illegal drugs, such as cocaine or amphetamines
  • Drink alcohol more often and more than is recommended (no more than 2 drinks per day for men and 1 drink per day for women)
  • Take certain antibiotics and over-the-counter allergy and cold medicines

Talk to your provider about how to prevent arrhythmias.

Here are some resources to help you prevent or manage heart disease:

 

Managing Blood Pressure Flyer

American Heart Association

 High Blood Pressure Resources Page (CDC)

Heart Health Articles and Videos (Healthwise)

 

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Fidelis Care Pharmacy Benefits and Authorizations
8/28/2024 • Posted by Provider Relations

Fidelis Care’s Pharmacy Services would like to provide clarification on how medications are covered under member’s medical and pharmacy benefits.

 

Medications Covered Under Fidelis Care Medical Benefit

  • Physician Administered Drugs – medications administered to a member during the course of an outpatient visit
    • Providers obtain medication via “buy-and-bill” or shipment to their practice site from a vendor of their choosing.
    • Coverage is dictated by Fidelis Care Authorization Grids, Prior Authorization Lookup Tool and/or Evolent Specialty Services (formerly NCH) Authorization Grids (Oncology Regimen Specific).
    • Medical Benefit Authorization Grids are plan specific.
    • If a medication is listed on one of the above Authorization Grids, a prior authorization is required prior to use/billing date of service in order to receive payment.
    • If a medication is not listed, no prior authorization needed
  • Physician administered drugs remain in-scope under the Fidelis Care Medical Benefit for Medicaid & HARP members (not impacted by NYS Pharmacy Benefit transition).
  • Medical Benefit Pharmacy prior authorizations can be faxed, submitted electronically via ePA, and/or called in to Fidelis Care directly.

 

Line of Business

Medical Benefit Initial Request Fax Number

Medical Benefit Appeals Request Fax Number

Medicare

844-235-5090

833-757-0611 (only for Part B)

Medicaid, CHP, EP, & Ambetter

844-235-5090

844-235-5091

 

Medications Covered Under Fidelis Care Pharmacy Benefit

  • Coverage is dictated by Fidelis Care Formularies.
    • Members obtain medications from community or retail outpatient pharmacies.
    • Pharmacy Benefit Formularies are plan specific.
    • Each formulary clearly indicates if a medication requires a prior authorization or not.  Non-formulary (NF) medications also require authorization prior to the prescription being filled at a community or retail outpatient pharmacy.
    • As of 4/1/2023, Medicaid & HARP Pharmacy benefits are administered by the NYS NYRx program. Visit the NYRx program website for information on the NYRx Preferred Drug List (PDL) and Prior Authorization submission requirements.
  • Pharmacy Benefit Pharmacy Prior Authorizations can be faxed, submitted electronically via ePA, and/or called in to Fidelis Care directly.

 

Line of Business

Pharmacy Benefit Initial Request Fax Number

Pharmacy Benefit Appeals Request Fax Number

Medicare

844-235-5021

866-388-1766

CHP, EP, & Ambetter

844-235-4852

888-865-6531

 

If you have any questions, please contact your Fidelis Care Provider Engagement Account Manager. To find your designated representative, please click here.