The purpose of this ALERT is to inform Providers that the way in which certain Medicaid members renew their coverage is changing. Medicaid MAGI individuals (eligible recipients through the Modified Adjusted Gross Income rules) may now need to renew their coverage through the NYSOH Marketplace rather than through the local Department of Social Services/ Welfare Management System (WMS.) Due to the large number of MAGI enrollees, the transition to NY State of Health Marketplace has been occurring in phases. The next phase of the transition will affect enrollees with a coverage end date of April 30, 2019. This will include Medicaid HARP (Health and Recovery Program) individuals who reside in all NY State counties, except for the five boroughs of NYC (Bronx, Kings, Manhattan, Queens, and Staten Island.)
This communication is to inform you that a change in the format of Fidelis Care's 835 (ERA) will take place on 3/28/2019. This update is informational only and will not affect receipt of your 835 files. ERAs delivered by Fidelis Care will no longer have the Bank Routing information in the BOP segment BPR09.
The following section of the Fidelis Care authorization grids has been updated effective May 1, 2019.
It is vital to educate our members on the importance of monitoring and controlling high blood pressure to prevent the increased risk of stroke and heart disease.
Like all other health plans, Fidelis Care is required by the State Department of Health (SDOH) to submit complete diagnostic data for members enrolled in New York State Medicaid Managed Care health plans. In order to meet this requirement, we request medical records to ensure all diagnostic data is reported completely and accurately.