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10/1/2019 • Posted by Provider Relations
Primary Care Providers (PCPs) (Family Practice, Internal Medicine, Obstetrics/Gynecology (OB/GYN), Pediatricians) who contract with Fidelis Care (Medicaid Managed Care (MMC) Plan) must meet specific appointment and availability standards to ensure that enrolled Medicaid members have appropriate access to necessary health care.
10/1/2019 • Posted by Provider Relations
Fidelis Care is pleased to inform you that the most recent 2019 QARR Non-Compliance Report has been posted on Provider Access Online (provider portal). This information is indicative of all encounter data on file with Fidelis Care as of 08/19/2019.
9/27/2019 • Posted by Provider Relations
The following sections of the Fidelis Care authorization grids have been updated effective October 1, 2019.
9/27/2019 • Posted by Provider Relations
As your health plan partner, Fidelis Care would like to inform you of the following updates to help ensure accuracy in claims submissions. For COB Submissions Received without Claims Attached...
9/27/2019 • Posted by Provider Relations
In collaboration with the NY State of Department of Health (SDOH), Fidelis Care encourages providers to share this information with patients to help them quit smoking and stay smoke free.
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Important Information on Coverage Decisions

Each day, Fidelis Care's Utilization Management (UM) Department makes decisions on numerous health insurance claims. These decisions are based only on appropriateness of care and the existence of coverage. 

Fidelis Care does not reward practitioners or other individuals for issuing denials of coverage, and does not offer financial incentives to UM staff that would encourage decisions that result in underutilization of services. 

Fidelis Care is committed to ensuring that members have the care and services they need. 

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