Renewal Information

• Review your eligibility verification procedures to make sure they include coverage end date information. Fidelis Care transmits coverage end dates in our real time electronic data interchange (EDI) 270/271 transactions (Instructions to access this information are available here: EDI Tip Sheet).  Most Fidelis Care members need to act starting 45 days from their coverage end date, with the deadline typically 15 days before coverage ends.
• Primary Care Providers - Routinely download your provider roster from the Fidelis Care Provider Portal . This roster contains the ‘recert date’ for your Fidelis Care patients. Share this date with your patients and let them know to contact us to stay insured.
• Distribute education materials from New York State and Fidelis Care about the renewal requirements and encourage members to get in touch with us for help.

The ‘recert date’ field published on the provider rosters of active members is the first date that members can take action to complete their renewal application on the NY State of Health Marketplace. 

It is typically 45 days before their coverage end date. The deadline for members to take action to maintain coverage without a lapse is 15 days prior to their coverage end date. It can also be helpful for you and your patients to understand when their coverage end date is if no action is taken.

For example, a member has coverage active through June 30, 2023 with eligibility through the NY State of Health Marketplace. The first date of action, also known as the recertification date, is May 16, 2023. The deadline for the member to take action without a risk of coverage lapsing is June 15, 2023. 

Members with recertification dates other than the 16^th of the month prior to their coverage ending have eligibility managed through their Local Department of Social Services or Human Resources Administration in NYC. Their recertification date is the deadline given on their renewal paperwork.

1. Redetermination/renewal is the annual process, required by New York State, for most Medicaid, HARP, MLTC, EP, and CHP members to maintain health insurance coverage. It has been paused since March 2020 due to the COVID-19 public health emergency (PHE).
2. New York State requires documentation around areas like income and household size to determine eligibility each year – either through an electronic process for those with eligibility on the NY State of Health website or through a paper process for those with eligibility through their county LDSS or HRA in NYC.
3. New York State will notify members based on their contact preference. For paperless renewals, members will receive an email alert when NY State of Health posts new notices to their online account. For printed renewals, notices will be mailed via US Postal Service from the HRA in NYC or local DSS.
4. If members need to provide information, the notification will provide instructions on next steps.
5. If members do not need to provide information, the notification will alert them that their renewal is complete.
6. Fidelis Care will also provide communications via email and phone outreach. Members should also log in to their Fidelis Care Member Portal account for information and guidance on next steps.
7. When connecting with us over the phone or in person at community offices or events, Fidelis Care can also look up the member’s recertification (renewal) date, and tell them when they will need to take action.
8. Based on the member’s renewal date, they can expect to receive communications about taking action to renew about 60 days before this date.
9. Fidelis Care can provide assistance at any point in the renewal process and answer any questions they may have. 

• Fidelis Care has developed educational materials (including print and digital) in multiple languages to help members understand the changes coming in the renewal process, and providers can help by making these materials available in their offices and during patient encounters.
• Providers can work with Fidelis Care to understand when their patients need to take action to keep their coverage and help communicate reminders and alerts to do so.
• Fidelis Care’s team of facilitated enrollers are available to come onsite to provider offices and locations at agreed upon timeframes to assist members in keeping their coverage and navigating through the renewal process.