Educational Materials

Medicaid Children's Improvement Project - Important Guidelines for Infants and Toddlers

Weight Assessment and Counseling for Children/Adolescents (WCC) - Provider Letter

Health Equity Resources for Health Care Professionals

• New York City Department of Education (DOE) Health Screening Guidance

A CMS-mandated program, the Chronic Care Improvement Program (CCIP) is designed to reduce hospitalizations for our Medicare members diagnosed with congestive heart failure. The program is closely aligned with the Million Hearts Campaign, which has a goal of significantly reducing the number of strokes and heart attacks over five years.

Similarly, the Quality Improvement Program (QIP) is designed to reduce all-cause re-admissions for Medicare members who have a heart failure diagnosis by focusing on medication adherence and care coordination. The QIP is aligned with the national Partnership for Patients campaign.

Fidelis Care is proud to provide the following links to additional information on best practices and clinical guidelines:

American College of Cardiology: Heart Failure and Cardiomyopathies 

Fidelis Care is committed to supporting members with chronic diseases through programs that help them better manage their health through a combination of education and care planning.

Once diagnosed, members can access our disease management programs in two ways: written information that is mailed to their home, or one-on-one phone outreach from a Nurse Case Manager. 

In addition, Fidelis Care Complex Case Managers help members who need extra health support. 

We provide important educational information in our newsletters and on our website, fideliscare.org, as well as through customized letters, brochures, and other materials that are sent to members.

Through our Disease Management and Complex Case Management Nurse Case Managers, Fidelis Care connects with members individually on a regular basis, helping to:

• Prevent or manage disease complications
• Coordinate care and appointments with primary care providers and specialists
• Coordinate care with caregivers and family members
• Manage medications
• Arrange for in-home equipment or services for more independent living
• Connect with community resources and services
• Make positive lifestyle changes
• Provide moral support

Fidelis Care’s Disease Management and Complex Case Management Nurse Case Managers also serve as a direct link between our members and their health care providers. We regularly contact provider offices by phone, fax, or letter to alert them of changes in a member’s health status or care, as well as to collect relevant medical data that may help us provide better service and assistance.

Fidelis Care regularly evaluates the effectiveness of our Disease Management and Complex Case Management programs, and we value your feedback and participation in this process. 

If you have questions or feedback about a specific Fidelis Care disease management program, complex case management programs or would like to refer a patient to one of our programs, please call 1-800-247-1441, or email triage@fideliscare.org.

Fidelis Care is proud to be your partner in providing the highest quality care and service to our members and your patients. 

Clinical Practice Guidelines have been developed to aid the practitioner in clinical decision-making for specific circumstances. Guidelines describe appropriate clinical care procedures and processes based on the best available scientific and peer-reviewed evidence and wide-ranging consensus—the main source for evidence-based care. The goal of evidence–based care is to support quality of care and consistency in healthcare delivery.

The United States Preventive Service Task Force (USPSTF) is a website containing recommendations for preventive health care services in primary care developed through scientific evidence reviews of clinical research. These recommendations can be found via ahrq.gov or uspreventiveservicestaskforce.org.

Choosing Wisely is an initiative of the ABIM Foundation that seeks to advance a national dialogue on avoiding unnecessary medical tests, treatments, and procedures. Choosing Wisely provides learning modules for clinicians to enhance communication skills, avoid unnecessary testing and overcome barriers to delivering high-value care.

Additionally, many professional organizations such as the American Academy of Pediatrics, the American Association of Clinical Endocrinologists, and the American College of Physicians develop clinical practice guidelines specific to their area of medical specialty.

Evolent Authorization Program
Fidelis Care has engaged Evolent, to coordinate a prior authorization program that manages outpatient (office and hospital) habilitative and rehabilitative physical medicine services, including services rendered in the home. 

This program is consistent with industry-wide efforts to manage the increasing utilization of these services and to ensure quality of care. All providers will be required to obtain prior authorization for physical medicine services, which includes physical therapy, occupational therapy, and speech therapy.

This program will include the following Fidelis Care health insurance products:

• Medicaid Managed Care (NYM)
• Child Health Plus(CHP)
• HealthierLife (HARP)
• Qualified Health Plans ("Metal-Level Products)
• Essential Plan (EP)

Submitting Prior Authorization Requests

• Please submit prior authorizations through the Evolent website at www.RadMD.com.
• To get started, go to www.RadMD.com click the New User button and submit a RadMD Application for New Account by selecting “Physical Medicine Practitioner.” Your RadMD login information should not be shared.

Further details regarding this prior authorization program can be found by viewing the resource links below.

• Physical Medicine Prior Authorization - Quick Reference Guide for Providers
• FAQ - Fidelis Care Physical Medicine Services Prior Authorization
• Fidelis Care Physical Medicine Request - Tip Sheet/Checklist

Foster Care and Family Resources