Foster Care Provider Education Update – Pharmacy Transition to NYRx
10/10/2023
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Posted by Provider Relations
Effective April 1, 2023, Medicaid Managed Care Plan members, including youth placed in foster care, pharmacy benefits transitioned to NYRx, the Medicaid Pharmacy program.
The pharmacy benefit requirements for youth placed in foster care include, but are not limited to, rapid replacement of medically necessary prescriptions and transitional fills for youth newly placed in foster care. Physicians administering drugs, durable medical equipment, prosthetics, orthotics, and supplies are still covered by Fidelis Care when billed as a medical or institutional claim as outlined in The Pharmacy Procedure Code Manual.
As a reminder, upon placement into Foster Care, the youth is required to have an Initial Medical Assessment within the first 30 days of the youth’s placement. The youth may utilize any primary care physician or qualified practitioner in the Fidelis Care’s network for the purposes of this Initial Medical Assessment.
For ongoing primary care visits, if there is a discrepancy with the assigned PCP on the member ID card, the child/youth should not be turned away; instead, please immediately call Fidelis Care at 1-888-FIDELIS (1-888-343-3547); TTY:711, to rectify this matter.
Provision and coordination of services for children/youth in foster care, must be done in compliance with the New York Medicaid Program 29-I Health Facility Billing Manual and the Transition of Children Placed in Foster Care and NYS Public Health Law Article 29-I Health Facility Services into Medicaid Managed Care guidance.
For additional questions, or if we can be of assistance in any way, please contact your Fidelis Care Provider Relations Specialist. To find your designated representative, please visit Contact Your Designated Provider Relations Specialist. Thank you for being a valued Fidelis Care partner in the provision of quality care.