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HomeProvidersProvider ResourcesQuality Information

Provider Quality

Provider-Quality


To ensure a continued focus on quality, Fidelis Care is dedicated to engaging with providers to ensure our members get the best care possible. Quality is a critical component of the work we do at Fidelis Care. The Provider Relations Department works diligently to support providers in quality improvement initiatives.


Hearthands

Quality Care Incentives (QCI) Program

Fidelis Care's QCI Program rewards groups/practices for providing recommended preventive care, for caring for members with chronic disease, and for comprehensive obstetrical care. As your health plan partner, we remain committed to rewarding our providers for achieving high-quality outcomes and have made significant changes to the program for measurement year 2024 to align with our shared goals, encourage participation, and recognize regional differences within New York State.

Fidelis Care’s Quality Care Incentives (QCI) Program is available on Provider Access Online. Once logged in, please navigate to the File Downloads section to access the brochure.

Within the brochure, we are providing a summary of the components of our QCI Program, along with the associated coding specifications, to help you drive improvements in quality and to reward you for your efforts. Fidelis Care also provides monthly care gap reports to track your incremental performance, and identify those patients who may benefit from needed care and services.

If you have any questions regarding Fidelis Care’s Quality Care Incentives, please contact your Quality Improvement Specialist.


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Quality Improvement Specialists
NYC Region:

Name Coverage Area Assigned Counties and/or Providers
Brianni Blue Loftlin 

✉ Email Address

Brooklyn County: 11201, 11203, 11205, 11206, 11207, 11212, 11217, 11211, 11213, 11221, 11226, 11220, 11237, 11238, 11239, 11243, 11249 Brooklyn County
 Yen Min Yau

✉ Email Address

ZIP Codes: 11220, 11204, 11214, 11229 Kings County

Providers: CAIPA & Excelsior Empire Health Brooklyn Providers
 Zinaida Khavasova

✉ Email Address

Kings County: 11219, 11223, 11224, 11229, 11235, 11230, 11204, 11209, 11214, 11228, 11232, 11210,11239, 11218 Kings County

Providers: Maimonides, One Brooklyn Health System: (Interfaith, Brookdale and Kingsbrook) 
 Michael Gayle

✉ Email Address

All ZIP Codes in the Bronx except for providers/groups assigned to an IPA (Balance, Bronx United) Bronx County

Providers: Boston Children's Health Physicians (Westchester County), Northwell (All Affiliated TINs) 
 Stanley Laforest

✉ Email Address

ZIP Codes: 10003, 10004, 10005, 10006, 10007, 10009, 10010, 10011, 10012, 10014, 10016, 10017, 10018, 10019, 10020, 10021, 10022, 10023, 10024, 10025, 10026, 10027, 10029, 10030, 10031, 10032, 10033, 10034, 10035, 10036, 10038, 10039, 10040, 10041, 10044, 10047, 10048, 10128 Various Counties
 Adebunmi (Bunmi) Browne

✉ Email Address

Various ZIP Codes Providers: Balance Medical IPA
 Osaruyi Eduwen

✉ Email Address

Queens County ZIP Codes: 11101, 11102, 11103, 11104, 11105, 11106, 11368, 11369, 11370, 11371, 11372, 11373, 11374, 11375, 11377, 11378, 11379, 11385 Queens County
 Rui Kang (Ray) Lin

✉ Email Address

Queens County ZIP Codes: 111354, 11355
 Queens County
Providers: CAIPA & Excelsior Empire Health Queens Provider
 Rosemond Guillaume

✉ Email Address

ZIP Codes: 11365, 11366, 11367, 11411, 11412, 11413, 11414, 11415, 11421, 11422, 11430, 11433, 11434, 11435; 11416, 11417, 11419, 11420, 11423, 11426, 11427, 11428, 11429, 11432, 11418, 11436, 11691, 11692, 11693, 11694, 11697
 Various Counties

 Taylor Panzarella
 ✉ Email Address


Rockland and Westchester Counties: 10977, 10952, 10956, 10901, 10954, 10965, 10980, 10970, 10960, 10989, 10927, 10994, 10923, 10920, 10962, 10983, 10913, 10993, 10974, 10984, 10986, 10968, 10964, 10976, 10931, 10911, 10982, 10701, 10801, 10573, 10705, 10583, 10550, 10704, 10562, 10598, 10710, 10558, 10566, 10557, 10708, 10552, 10703, 10567, 10605, 10543, 10591, 10603, 10805, 10549, 10580, 10804, 10538, 10606, 10528, 10514, 10530, 10803, 10604, 10553, 10570, 10536, 10601, 10520, 10707, 10522, 10523, 10595, 10510, 10709 Rockland and Westchester County

 Haneefah Mahdi

✉ Email Address

Richmond County ZIP Codes: 10301, 10302, 10303, 10304, 10305, 10304, 
10305, 10306, 10307, 10308, 10309, 10310, 10311, 10312, 10313, 10314 		Richmond County

Providers: Amboy Medical Practice, Bon Secours, NYC  Health & Hospitals, Refuah Health Center
 Leidy Mejia

✉ Email Address

Nassau County ZIP Codes: 11096, 11509, 11510, 11516, 11518, 11520, 11550, 11552, 11553, 11554, 11555, 11557, 11558, 11559, 11563, 11565, 11566, 11570, 11572, 11575, 11580, 11581, 11598, 11709, 11710, 11756, 11758, 11762, 11783, 11793,11001, 11020, 11021, 11023, 11024, 11030, 11040, 11042, 11050, 11501, 11507, 11514, 11530, 11542, 11545, 11548, 11560, 11568, 11576, 11577, 11579, 11590, 11596, 11714, 11732, 11735, 11753, 11771, 11791, 11797, 11801 Nassau County
 Robert Dean

✉ Email Address

Suffolk County ZIP Codes: 11720, 11721,  11724, 11725,11729;11731, 11733, 11738, 11740, 11741, 11742, 11743, 11746, 11747, 11754, 11757, 11763, 11764, 11766, 11768, 11769, 11776, 11777, 11778, 11780, 11782, 11784, 11786, 11787, 11788, 11790, 11794, 11901, 11930, 11931, 11933, 11934, 11935, 11937, 11939, 11940, 11941, 11942, 11944, 11946, 11948, 11949, 11950, 11951, 11952, 11953, 11954, 11701, 11702, 11703, 11704, 11705, 11706, 11707, 11708, 11709, 11713, 11715, 11716, 11717, 11718, 11722, 11727, 11750, 11751, 11752, 11755, 11767, 11772, 11779, 11789, 11792, 11795, 11796, 11798, 11955, 11957, 11958, 11959, 11961, 11962, 11963, 11964, 11965, 11967, 11968, 11970, 11971, 11975, 11976, 11977, 11978, 11980 Suffolk County
 Kay Stewart-Benjamin

✉ Email Address

Kings County: 11238, 11212, 11234, 11236 Kings County

Providers: NYU and Affiliates,  NYPHS and Affiliates, Mount Sinai and Affiliates
 Nadia Oleniak

✉ Email Address

ZIP Codes: 02886, 06484, 06518, 07020, 10002, 10003, 10006, 10007, 10010, 10013, 10016, 10017, 10019, 10027, 10023, 10025, 10029, 10032, 10034, 10036, 10037, 10075, 0301, 10304, 10305, 10312, 10451, 10452, 10455, 10457, 10458, 10459, 10461, 10462, 10463, 10464, 10466, 10469, 10508, 10523, 10604, 10952, 11042, 11102,  11103, 11104, 11203, 11204, 11206, 11207, 11208, 11209, 11210, 11212, 11213, 11214, 11215, 11216, 11218, 11219, 11220, 11223, 11224, 11226, 11228, 11229, 11230, 11234, 11235, 11236, 11237, 11238,  11354, 11355, 11358, 11360, 11361, 11362, 11364, 11365, 11368, 11372, 11373, 11374, 11375, 11377, 11385, 11411, 11416, 11418, 11419, 11423, 11427, 11432, 11435, 11436, 11691, 11772, 11940 Various Counties
 Steven Lee

✉ Email Address

ZIP Codes: 10002, 10013, 10314

 Counties: Manhattan, Richmond

Providers: Charles B. Wang Community Health Center, CAIPA Manhattan Providers, Excelsior Empire Health Manhattan Providers, CAIPA Staten Island Providers


Upstate Regions:

Name Coverage Area
 Assigned Counties and/or Providers
 Jane Sanderson

✉ Email Address

Rensselaer County: 12180, 12144, 12182, 12061, 12033, 12198, 12090, 12179, 12018, 12123, 12196, 12154, 12138, 12121, 12094, 12185, 12168, 12062, 12052, 12156, 12140, 12153, 12028 ,12057, 12022 12169, 12063, 12082, 12181, 12089, 12133, 12040                                                                                   

Saratoga County:  12065, 12866, 12020, 12010, 12831, 12118, 12019, 12188, 12828, 12803, 12148, 12822, 12170,  12871, 12025, 12833, 12134, 12027, 12850, 12074,12859, 12835, 12151, 12863, 12086,  12884 

Schenectady County:  12008, 12053, 12056, 12137 , 12141, 12150 , 12301, 12302, 12303, 12304, 12305 , 12306 ,12307,12308, 12309, 12325, 12345  

Washington County:  12839, 12828, 12834, 12832, 12887, 12827, 12816, 12865, 12809, 12154, 12094, 12821, 12185, 12028, 12057, 12837, 12873, 12861, 12819, 12823, 12838, 12849, 12841, 12844, 12848, 12854 
 Counties: Rensselaer, Saratoga, Schenectady, Washington


 Barbara Bentley-Morrill

✉ Email Address

Albany County: 12309, 12203, 12205, 12303, 12047, 12208, 12304, 12110, 12189, 12054, 12206, 12211, 12210, 12209, 12009, 12202, 12159, 12204, 12077, 12158, 12186, 12143, 12084, 12053, 12083, 12111, 12183, 12262, 12222, 12023, 12067, 12207, 12193, 12059, 12087, 12469, 12046, 12120, 12147, 12226, 12460, 12041, 12234, 12085, 12007, 12201, 12212, 12214, 12220, 12223, 12224, 12225, 12227, 12228, 12229, 12230, 12231, 12232, 12233, 12235, 12236, 12237, 12238, 12239, 12240, 12241, 12242, 12243, 12244, 12245, 12246, 12247, 12248, 12249, 12250, 12255, 12257, 12260, 12261, 12288, 12107, 12128, 12161, 12045, 12055

Clinton County:  12901, 12972, 12962, 12918, 12992, 12919, 12944  12981, 12910, 12958, 12921, 12935, 12912, 12903 ,12979, 12929 ,12959, 12985, 12934, 12923, 12955, 12952, 12911, 12924, 12978, 12933 

Columbia County: 12534, 12571, 12184, 12526, 12037, 12075, 12546, 12106, 12529, 12583, 12567, 12060, 12173, 12516, 12521, 12523, 12156, 12125, 12029, 12502, 12136, 12565, 12503, 12017, 12130, 12513, 12517, 12115, 12024, 12165, 12132, 12593, 12174, 12530, 12195, 12172, 12050, 12541, 12544

Essex County: 12983, 12946, 12883, 12944, 12928, 12912, 12870, 12941, 12960, 12974, 12996, 12932, 12997, 12993, 12943, 12950, 12851, 12936, 12987, 12913, 12956, 12857, 12852, 12942, 12998, 12964, 12961, 12855, 12858, 12975, 12977, 12872, 12879 

Franklin County: 12953, 12983, 12986, 12966, 13655, 12920, 12926, 12916, 12957, 12937, 12917, 12980, 12989, 12914, 12970, 12945, 12930, 12976, 12913, 12955, 12969, 12995, 12915, 12939, 13683   

Greene County: 12414, 12051, 12143, 12083, 12015, 12413, 12192, 12496, 12058, 12463, 12431, 12468, 12451, 12087, 12430, 12423, 12473, 12427, 12436, 12442, 12405, 12480, 12418, 12470, 12424, 12450, 12444, 12485, 12492, 12482, 12422, 12454, 12407, 12460, 12042, 12176, 12439, 12490, 12452, 12124   

Warren County: 12804, 12801, 12845, 12885, 12846, 12817, 12853, 12814, 12856, 12843, 12815, 12824, 12878, 12808, 12836, 12810, 12860, 12874, 12844, 12862, 12886, 12811, 12820  
 Counties: Albany, Clinton, Essex, 
Columbia, Greene, Warren

Providers: All Vermont Providers, Silver Springs Health Care Management, Saratoga Regional Medical, Twin River Medical

 Jaime Laube

✉ Email Address

Orange County: 10950, 12550, 10940, 12553, 10990, 12589, 10941, 10924, 12771, 10918, 12566, 12549, 10980, 12586, 10930, 10992, 10928, 12721, 12518, 10963, 10916, 10998, 10921, 10987, 10925, 12575, 10958, 10926, 12577, 12780, 12520, 10973, 10986, 12729, 12746, 12543, 10969, 10996, 10917, 10919, 10975, 10914, 10922, 10933, 12785, 10911, 10943, 10985, 10910, 10912, 10915, 10932, 10949, 10953, 10959, 10979, 10981, 10988, 10997, 12551, 12552, 12555, 12584  

Putnam County: 10541, 10512, 10509, 12563, 10579, 10516, 10524, 12531, 10588, 10537, 10542

Sullivan County: 12701, 12721, 12754, 12790, 12758, 12788, 12747, 12776, 12783, 12775, 12764, 12723, 12789, 12729, 12768, 12740, 12748, 12737, 12779, 12763, 12734, 12726, 12719, 12733, 12759, 12732, 12777, 12765, 12751, 12760, 12762, 12786, 12725, 12766, 12742, 12743, 12770, 12785, 12778, 12741, 12720, 12745, 12738, 12750, 12724, 12749, 12736, 12769, 12787, 12791, 12792, 12752, 12767, 12781, 12784, 12722, 12727  

Ultser County:  12401, 12477, 12561, 12589, 12528, 12566, 12428, 12446, 12542, 12758, 12443, 12487, 12498, 12404, 12525, 12547, 12449, 12484, 12466, 12458, 12548, 12455, 12440, 12491, 12461, 12740, 12486, 12515, 12409, 12494, 12472, 12464, 12406, 12481, 12410, 12480, 12456, 12457, 12433, 12725, 12411, 12419, 12435, 12495, 12416, 12412, 12448, 12475, 12429, 12465, 12493, 12490, 12471, 12441, 12489, 12483, 12782, 12402, 12417, 12420, 12432, 12453, 12568, 12588  

 Counties: Orange, Putnam,
Sullivan, Ulster

Providers: Hudson Valley Regional Community Health
 Penny Patterelli

✉ Email Address

Oneida County: 13440, 13501, 13502, 13413, 13421, 13323, 13492, 13403, 13316, 13309, 13308, 13354, 13476, 13478, 13480, 13456, 13438, 13495, 13471, 13461, 13042, 13424, 13417, 13363, 13318, 13425, 13490, 13431, 13054, 13304, 13477, 13338, 13328, 13303, 13322, 13321, 13486, 13441, 13469, 13319, 13494, 13440, 13501, 13502, 13413, 13421, 13323, 13492, 13403, 13316, 13309, 13308, 13354, 13476, 13478, 13480, 13456, 13438, 13495, 13471, 13461, 13042, 13424, 13417, 13363, 13318, 13425, 13490, 13431, 13054, 13304, 13477, 13338, 13328, 13303, 13322, 13321, 13486, 13441, 13469, 13319, 13494, 13483, 13157, 13455, 13352, 13162, 13301, 13435, 13341, 13362, 13401, 13313, 13123, 13442, 13449, 13479, 13503, 13504, 13505, 13599  

Otsego County:  13820, 13326, 13849, 13439, 13491, 13411, 13825, 12197, 13843, 13320, 12155, 13809, 13807, 13810, 13335, 13315, 13808, 13750, 12116, 13485, 13348, 13796, 13361, 13337, 13468, 13861, 12064, 13776, 13450, 12036, 13342, 13333, 13415, 13488, 13859, 13860, 13457, 13482, 13747, 13834   

Schoharie County: 12043, 12053, 12122, 12157, 12149, 12023, 13459, 12066, 12093, 12167, 12092, 12076, 12469, 12160, 12187, 12175, 12035, 12064, 12031, 12036, 12194, 12071, 12131, 12073
 Counties: Oneida, Otsego,
Schoharie
 Jeannie Vanhoeven

✉ Email Address

Fulton County: 12010, 12078, 12095, 12025, 13452, 13329, 12117, 12070, 12032, 12086, 13470 

Hamilton County: 12134, 13324, 12842, 13454, 12856, 12032, 12108, 12847, 12190, 13360, 12139, 13436, 12812, 12164, 13353, 12864

Montgomery County: 12010, 13339, 13452, 13317, 12068, 12072, 12070, 12066, 12166, 12137, 13428, 12086, 12177, 13410, 12069, 12016  

Saint Lawrence County: 13662, 13676, 13669, 13617, 13642, 12986, 13667, 13668, 13658, 13646, 13613, 13654, 13697, 13625, 13648, 13679, 13660, 13652, 13630, 13684, 13694, 13680, 13681, 12980, 13621, 12967, 13635, 12914, 13690, 13687, 13672, 13670, 13633, 12927, 12965, 13614, 13666, 13695, 13664, 12922, 13639, 12973, 13649, 12949, 13623, 13645, 13647, 13677, 13678, 13696, 13699 

Herkimer County: 13502, 13350, 13357, 13367, 13365, 13340, 13339, 13407, 13439, 13329, 13456, 13491, 13438, 13416, 13324, 13431, 13338, 13322, 13454, 13420, 13361, 13690, 13670, 13494, 13406, 13472, 13331, 13475
 Counties: Fulton, Hamilton, Montgomery, Saint Lawrence, Herkimer

Providers: Bernadot Pediatrics, Whitney M Young Health, Northern Medical Group, Nuvance Health Medical Practice, St Regis Mohawk Tribe 





 Sarah Freyer

✉ Email Address

Broome County: 13760, 13850, 13905, 13790, 13903, 13901, 13904, 13865, 13803, 13862, 13833, 13748, 13787, 13795, 13746, 13754, 13730, 13797, 13835, 13813, 13744, 13802, 13777, 13737, 13745, 13749, 13761, 13762, 13763, 13794, 13826, 13848, 13851, 13902

Chenango County: 13815, 13778, 13830, 13733, 13460, 13787, 13411, 13746, 13040, 13730, 13332, 13843, 13809, 13052, 13464, 13813, 13072, 13801, 13844, 13780, 13129, 13832, 13155, 13136, 13841, 13758, 13124, 13814   

Delaware County: 13820, 13856, 13753, 13849, 13838, 13754, 13783, 12776, 12455, 12093, 13775, 12167, 13788, 12474, 13750, 13839, 12468, 13757, 13752, 13739, 12406, 12430, 13731, 13782, 13755, 13842, 12760, 13756, 13740, 12421, 13846, 13786, 12465, 13804, 13806, 12438, 13751, 12434, 13837, 13774, 13860, 12459, 13847 

Madison County: 13032, 13421, 13037, 13035, 13346, 13082, 13491, 13408, 13030, 13409, 13332, 13402, 13334, 13355, 13052, 13485, 13072, 13061, 13122, 13310, 13418, 13163, 13314, 13364, 13043, 13134, 13465, 13484  

Dutchess County: 12603, 12601, 12590, 12533, 12508, 12524, 12538, 12569, 12571, 12572, 12540, 12564, 12570, 12582, 12522, 12545, 12580, 12531, 12594, 12546, 12581, 12514, 12501, 12583, 12578, 12567, 12592, 12585, 12507, 12604, 12574, 12602, 12504, 12506, 12510, 12511, 12512, 12527, 12537 		Counties: Broome, Chenango, Delaware, Madison, Dutchess

Providers: Columbia Family Medience Clinic, Kudos Medical, Oneida Nation Health Services

 Maureen Hudson

✉ Email Address

Erie County ZIP Codes: 14004, 14026, 14031, 14043, 14051, 14059, 14086, 14094, 14202, 14203, 14206, 14209, 14212, 14214, 14215, 14216, 14217, 14220, 14225, 14226 Counties: Erie, Niagara

Providers: Mount St. Mary's Hospital, Primary Care of WNY, Sisters Hospital, Trinity Medical WNY, WNY Medical                                         
 Christine Santiago

✉ Email Address

Allegany County: 14706, 14709, 14711, 14715, 14727, 14802, 14803, 14804, 14806, 14813, 14822, 14880, 14884, 14895

Cattaraugus County: 14042, 14070, 14101, 14138, 14171, 14706, 14723, 14727, 14731, 14737, 14760, 14772, 14779

Chautauqua County: 14701, 14702, 14048, 14063, 14136, 14787

Steuben County: 14572, 14810, 14898
 Counties: Allegany, Cattaraugus, Chautauqua, Erie, Niagara, Steuben

Providers: Family Health Medical Services, Great Lakes Physician Practice, Jamestown Pediatrics, Jones Memorial, Keuka Family Practice, UPMC
 Christine Jendraszek

✉ Email Address

Various  
 Counties: Monroe, Orleans, Niagara

Providers:  Anthony Jordan, Erie County Medical Corporation, Kaleida Health, Oak Orchard, Niagara Falls Memorial Hospital, Paul DeJac  
 Robert Chantra

✉ Email Address

Ontario County: 14424, 14456, 14564, 14425, 14522, 14469, 14432, 14487, 14548, 14512, 14532, 14485, 14561, 14471, 14560, 14544, 14466, 14504, 14475, 14537, 14585, 14461, 14463, 14518, 14443, 14453, 14547 Counties: Monroe and Ontario 

Providers: Canton-Potsdam Hospital, Canton-Potsdam Medical Practice, Gouverneur Hospital, GRIPA, Guthrie Medical Group, Massena Hospital, St Lawrence Health Systems, Strong/University of Rochester              
 Nicole Lloyd

✉ Email Address

Cayuga County: 13021, 13022, 13024, 13026, 13033, 13034, 13064, 13071, 13081, 13092, 13111, 13113, 13117, 13118, 13139, 13140, 13147, 13156, 13160 and 13166

Chemung County: 14814, 14816, 14825, 14838, 14845, 14861, 14864, 14871, 14872, 14889, 14894, 14901, 14902, 14903, 14904 and 14905

Jefferson County: 13601, 13602, 13603, 13605, 13606, 13607, 13608, 13611, 13612, 13615, 13616, 13618, 13619, 13622, 13624, 13628, 13632, 13634, 13636, 13637, 13638, 13640, 13641, 13643, 13650, 13651, 13656, 13659, 13661, 13665, 13671, 13673, 13674, 13675, 13679, 13682, 13685, 13691, 13692 and 13693

Lewis County: 13305, 13309, 13312, 13325, 13327, 13343, 13345, 13367, 13368, 13404, 13433, 13473, 13489, 13620, 13626, 13627, 13631, 13648 

Schuyler County: 14886, 14837, 14891, 14812, 14865, 14818, 14864, 14869, 14878, 14824, 14805, 14841, 14815, 14876, 14887, 14863

Seneca County:  14850, 14456, 13165, 13148, 14886, 14532, 14521, 13146, 14847, 14541, 14860, 14841, 13065, 14588

Yates County: 14415, 14418, 14441, 14478, 14507, 14527, 14544, 14837, 14842, 14857 and 14878
 Counties: Cayuga, Chemung, Jefferson, Lewis, Schuyler, Seneca and Yates

Providers: Lewis County General Hospital, Arnot Ogden, Arnot Medical Services, Auburn Community Hospital and Auburn Memorial Medical Services, Finger Lakes Migrant 
 Karen Yonkers-Santy

✉ Email Address

Cortland County: 13045, 13077, 13159, 13803, 13053, 13040, 13101, 13835, 13052, 13158, 13141, 13863, 13841, 13087, 13738, 13056, 13784

Oswego County: 13126, 13069, 13036, 13114, 13142, 13135, 13074, 13167, 13132, 13131, 13044, 13042, 13493, 13076, 13111, 13083, 13661, 13302, 13145, 13144, 13028, 13437, 13103, 13426, 13093, 13107, 13115, 13121                                
Tioga County:  13760, 13827, 14892, 13732, 13811, 14883, 13743, 13812, 13736, 13734, 13835, 13864, 14859, 13840, 13845            

Tompkins County: 14850, 13068, 14886, 13073, 14867, 13053, 14883, 14882, 13736, 14817, 13864, 14853, 14881, 14852, 13062, 13102, 14851, 14854
 Counties: Cortland, Oswego, Tioga,
Tompkins

Providers: Family Health Network of CNY, Northern Oswego County Health Services Inc., Oswego County OB-GYN
 Peter Stone

✉ Email Address

Onondaga County: 13027, 13090, 13210, 13208, 13212, 13088, 13204, 13039, 13203, 13205, 13206, 13031, 13104, 13057, 13219, 13215, 13207, 13041, 13066, 13209, 13078, 13260, 13224, 13152, 13214, 13029, 13202, 13077, 13108, 13211, 13135, 13159, 13084, 13082, 13080, 13120, 13030, 13116, 13110, 13164, 13060, 13063, 13112, 13141, 13122, 13020, 13153, 13201, 13217, 13218, 13220, 13221, 13225, 13235, 13244, 13250, 13251, 13252, 13261, 13290, 13051, 13089, 13119, 13137, 13138 Onondaga County                                                                                         
Providers: Brighton Hill Pediatrics, Buckley Road Pediatrics, Camillus Family Health Associates, Crouse Medical Practice, Department of Medicine, Family Care Medical Group, Lyndon Pediatrics, Pediatric Service Group, Pediatric Associates, Summerwood Pediatrics, Trinity Partners including: St Joseph Hospital Health Center, St Josephs Medical PC, St Peters Health Partners, St Peters Health Partners Medical Associates, Samaritan Hospital of Troy, Upstate Family and Preventative Medicine

 Marissa Harvey

✉ Email Address

 Main Street Rural Health, Providers Only All providers regardless of county that are part of Main Street Rural Health
 Abenaa Danquah

✉ Email Address

Erie County: 14026, 14031, 14051, 14059, 14086, 14202, 14203, 14206, 14209, 14212, 14215, 14217, 14224, 14225 and 14226 Select providers in all of the following counties: Monroe, Cattaraugus, Chautuaqua, Erie, Niagara, Onondaga,  Steuben, Schuyler, Tompkins, and Wyoming                                                                                         
Providers: Alicia W Hermogenes, MD, PC, Allegany Family Medicine, Bohdan Dejneka, MD dba Holiday Pediatrics, Danilo Saldana, Denise C Wolken, MD, PLLC, 
Eastside Pediatrics, PLLC, Edward OBrien III, MD, 
Erie County Health Dept/ECHD Accounting Office, Family Practice Associates of Dryden, Finger Lakes Internists, LLP, Intention Internal Medicine, J&E Medical Specialties, PC, Jones Medical, PLLC dba: Syracuse Pediatrics, Mendon Pediatrics, PLLC, Michael Cilip, MD, Northeast Pediatrics & Adolescent Medicine, LLP, Patchwork Pediatrics, Philip Penepent, Phillip M Schirck, MD, PLLC, Phoenix Rising Medical, PC, Reach Medical PLLC, South Street Health Services Family Health & Psychiatry


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Your provision of quality care and services to our members contributes greatly to Fidelis Care’s success. One of the ways Fidelis Care prioritizes quality is making sure you are satisfied with your experiences. Our annual Provider Satisfaction Survey identifies areas to focus on for further improvement in the coming year. The Provider Relations Department works diligently to identify an action plan to address areas of improvement, while continuing to develop actions and interventions to improve the provider experience.

HEDIS® Measurement Year 2025 Toolkit

HEDIS® is a tool used by more than 90% of America’s health plans to measure performance on important dimensions of care and service. We've developed this toolkit to help identify required preventive services.

Resources

Fidelis Care offers resources including Provider Bulletins, tip sheets, educational materials, blog posts, and more to keep you informed.


 

SUMMER 2025 PROVIDER BULLETIN


  • Championing Mental Health: Early Intervention is Key
  • Important Reminders About HIV Prevention and Testing
  • Supporting Maternal Health for Healthy Pregnancies and Babies
  • Encourage Preventive Cancer Screenings
  • Help Your Patients of All Ages Stay Active!

 

Vol. 11 Issue 3 (PDF)

 

Provider Quality News


Fidelis Care Authorization Grids Effective May 1, 2025
3/27/2025 • Posted by Provider Relations in Provider News

The following section of the Fidelis Care authorization grids have been updated effective May 1, 2025.

 

The following codes have been updated on the Medicare, Medicaid, Essential Plan, and Ambetter Metal-Level Products Authorization Grids and require prior authorization:

III.       Outpatient surgery: The following services require prior authorization:           

D.  Skin surgery and other dermatological procedures:

  • 11730  requires an authorization when billed with REV codes 0360, 0361 and 0490
  • Only the following codes require authorization for any place of service: A2030, A2031, A2032, A2033, A2034, A2035, 11200, 11201, 11719, 15769 - 15829, 17340-17999, Q4354, Q4355, Q4356, Q4357, Q4358, Q4359, Q4360, Q4361, Q4362, Q4363, Q4364, Q4365, Q4366, Q4367

R. Other: C1600, C1601, C1602, C1603, C1604, C1737, C7556, C7557, C7560, C9807, 23140, 54360 , 60660, 60661

 

The following codes have been updated on the Medicare Authorization Grid and require prior authorization:

V.  Counseling Services Authorization requirements are indicated.

A.     Medical Nutrition Therapy (MNT)    

  • Up to 12 visits per year are covered without an authorization using codes 97802 or 97803 or G0270 and G0271. A 15 or a 30 minute session counts as one  visit

             

The following DME codes have been updated on the Medicare, Medicaid, Essential Plan, and Metal-Level Products Authorization Grids and require prior authorization:

A6515

Gradient compression wrap with adjustable straps, full leg, each, custom

A6516

Gradient compression wrap with adjustable straps, foot, each, custom

A6517

Gradient compression wrap with adjustable straps, below knee, each, custom

A6518

Gradient compression wrap with adjustable straps, arm, each, custom

A6519

Gradient compression garment, not otherwise specified, for nighttime use, each

A6611

Gradient compression wrap with adjustable straps, above knee, each, custom

E0201

Penile contracture device, manual, greater than 3 lbs traction force

E1022

Wheelchair transportation securement system, any type includes all components and accessories

E1023

Wheelchair transit securement system, includes all components and accessories

E1032

Wheelchair accessory, manual swingaway, retractable or removable mounting hardware used with joystick or other drive control interface

E1033

Wheelchair accessory, manual swingaway, retractable or removable mounting hardware for headrest, cushioned, any type

E1034

Wheelchair accessory, manual swingaway, retractable or removable mounting hardware for lateral trunk or hip support, any type

E1832

Static progressive stretch finger device, extension and/or flexion, with or without range of motion adjustment, includes all components and accessories

L0720

Cervical-thoracic-lumbar-sacral-orthoses (ctlso), anterior-posterior-lateral control, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise

L1933

Ankle foot orthosis, rigid anterior tibial section, total carbon fiber or equal material, prefabricated, off-the-shelf

L1952

Ankle foot orthosis, spiral, (institute of rehabilitative medicine type), plastic or other material, prefabricated, off-the-shelf

L5827

Endoskeletal knee-shin system, single axis, electromechanical swing and stance phase control, with or without shock absorption and stance extension damping

L6028

Partial hand including fingers, flexible or non-flexible interface, endoskeletal system, molded to patient model, for use without external power, not including inserts described by l6692

L6029

Upper extremity addition, test socket/interface, partial hand including fingers

L6030

Upper extremity addition, external frame, partial hand including fingers

L6031

Replacement socket/interface, partial hand including fingers, molded to patient model, for use with or without external power

L6032

Addition to upper extremity prosthesis, partial hand including fingers, ultralight material (titanium, carbon fiber or equal)

L6033

Addition to upper extremity prosthesis, partial hand including fingers, acrylic material

L6037

Immediate post-surgical or early fitting, application of initial rigid dressing, including fitting alignment and suspension of components, and one cast change, partial hand including fingers

L6700

Upper extremity addition, external powered feature, myoelectronic control module, additional emg inputs, pattern-recognition decoding intent movement

L7406

Addition to upper extremity, user adjustable, mechanical, residual limb volume management system

 

The following section of the Fidelis Care authorization grids have been updated effective April 1, 2025.

 

The following codes have been updated on the Medicaid, CHP, Essential Plan, and Ambetter Metal-Level Plans Authorization Grids and require prior authorization:

J2428     paliperidone palmitate extended release inj (Erzofri)

 

The following codes have been updated on the Medicaid, CHP, Essential Plan, Ambetter Metal-Level Plans, and Medicare Authorization Grids and require prior authorization:

C9301    obecabtagene autoleucel (Auctazyl)

C9302    zanidatamab-hrii inj (Ziihera)

C9303    zolbetuximab-clzb inj (Vyloy)

C9304    marstacimab-hncq inj (Hympavzi)

J0281     aminocaproic acid inj

J1072     testosterone cypionate inj, (Azmiro)

J1299     eculizumab inj (Soliris)

J2351     ocrelizumab and hyaluronidase-ocsq inj (Ocrevus Zunovo)

J2804     rifampin inj

J9024     atezolizumab and hyaluronidase-tqjs inj (Tecentriq Hybreza)

J9038     axatilimab-csfr inj (Niktimvo)

J9054     bortezomib inj (Boruzu)

J9161     denileukin diftitox-cxdl inj (Lymphir)

Q2057   Afamitresgene autoleucel (Tecelra)

Q5147   aflibercept-ayyh inj (Pavblu)

Q5148   filgrastim-txid inj (Nypozi)

Q5149   aflibercept-abzv inj (Enzeevu)

Q5150   aflibercept-mrbb inj (Ahzantive)

Q5151   eculizumab-aagh inj (Epysqli)

Q5152   eculizumab-aeeb inj (Bkemv)

Q9999   ustekinumab-aauz inj (Otulfi)

 

The following codes require Evolent Oncology (NCH) review for Medicaid, CHP, Essential Plan, Ambetter Metal-Level Plans:

C9302    zanidatamab-hrii inj (Ziihera)

C9303    zolbetuximab-clzb inj (Vyloy)

J9024     atezolizumab and hyaluronidase-tqjs inj (Tecentriq Hybreza)

J9054     bortezomib inj (Boruzu)

J9161     denileukin diftitox-cxdl inj (Lymphir)

Q5148   filgrastim-txid inj (Nypozi)

 

Visit:  Authorization Grids