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

If you have any questions, please contact your Quality Improvement Specialist.

Quality Improvement Specialists

New York Regions:

Name	Coverage Area	Assigned Providers
Yen Min Yau ✉ Email Address	Kings County	CAIPA & Excelsior EmpireHealth Brooklyn Providers
Zinaida Khavasova ✉ Email Address	Various Counties in the NYC Region	Maimonides and affiliates, One Brooklyn Health System: (Interfaith, Brookdale and Kingsbrook), South Asian IPA
Stanley Laforest ✉ Email Address	Various Counties in the NYS Region	Bronx United IPA, Hudson Heights IPA
Adebunmi (Bunmi) Browne ✉ Email Address	Various Counties in the NYC Region	Balance Medical IPA
Rui Kang (Ray) Lin ✉ Email Address	Queens County	CAIPA & Excelsior EmpireHealth Queens Provider
Rosemond Guillaume ✉ Email Address	Various Counties in the NYC Region	AdvantageCare, Jamaica Hospital, Prominis Care IPA LLC DBA STAR, YUVO IPA
Haneefah Mahdi ✉ Email Address	Richmond and Bronx Counties	Amboy Medical Practice Bon Secours NYC Health & Hospitals Refuah Health Center, Emilio Perez
Robert Dean ✉ Email Address	Suffolk and Nassau Counties	Healthcare Partners, CHS Physician Partners, Quest Medical Care, PC, Central Queens IPA
Kay Stewart-Benjamin ✉ Email Address	Kings County	NYU and Affiliates, Doral Medical and Multi Specialty Facility, The Brooklyn Hospital, SUNY Downstate, New York Network Management
Nadia Oleniak ✉ Email Address	Various Counties in the NYC Region	Queens Medical Services, PLLC, New York Senior Medical Group, Empire Physicians IPA
Steven Lee ✉ Email Address	Manhattan and Richmond Counties	Charles B. Wang Community Health Center, CAIPA Manhattan Providers, Excelsior EmpireHealth Manhattan Providers, CAIPA Staten Island Providers
Barbara Bentley-Morrill ✉ Email Address	Counties: Albany, Clinton, Columbia, Essex, Green, Warren, All Vermont; Saratoga, Schenectady, Rensselaer	Northwell and Nuvance, NYPHS and Affiliates, Whitney M. Young, Saratoga Hospital, Saratoga Regional Medical, Twin Rivers Medical, NY Presby; Nuvance
Jaime Laube ✉ Email Address	Counties: Orange, Putnam, Sullivan, Ulster; Dutchess	Hudson Valley Regional Community Health, Montefiore Medical Center, Union Community Health Center
Christine Jendraszek ✉ Email Address	Various Counties in the Buffalo Region, Cattaraugus and Yates Counties	CINQ Upstate: EHS, INC., Care Medical Practice, Community Health Center of Buffalo, Jericho Road Ministries, Medical Health Associates for Western NY, INC. Southertier Community Health Center Networks, INC., The Chautauqua Center, INC, Tri-County Family Medicine Program, INC., Lakeshore Family Medicine Associates, Liberty Resources, Ted J. Triana, Urban Family Practice, Westfield Family Physicians, John Mulawka-dba Southtowns Pediatrics, Lynne Ross dba Canalside Primary Care, Mobile Physicians Services PLLC, Robert Ericson Do &Jennifer Ericson Do dba Inspired Health Group, Highgate Medical Grop, PC. Northeast Medical, PC. Kenmore Family Medicine.
Karen Yonkers-Santy ✉ Email Address	Counties: Cortland, Oswego, Schuyler, Seneca, Tioga, Tompkins, Westchester	FLIPA- Family Health Network of CNY, Northern Oswego County Health Servies Inc, Upstate Family Health Center, Inc. Other: Cayuga Medical Associates, Oswego County OB-GYN, New York Senior Medical Group; William F. Ryan Community Health Center, Ryan Chelsea Clinton Community Health , Cayuga Health Partners
Maureen Hudson ✉ Email Address	Erie and Chautauqua Counties	Catholic Medical Partners (CMP) Sisters Of Charity Hospital, Mount St. Mary's Hospital , Trinity Medical of WNY, PC., WNY Medical PC, Primary Care of WNY, Summit Pediatrics, Lockport Pediatrics, Frank Laurri, M.D. & Associates, Southgate Medical Group; Family Health Medical Services, UPMC Chautauqua WCA, Jamestown Pediatrics, Southerntier Pediatrics, Great Lakes Physicians Practice, PC. (GLPP), Community Inclusion
Penny Patterelli ✉ Email Address	Counties: Oneida, Onondaga, Otsego, Schoharie	IPA: Trinity Health Providers: St. Peters' Health Partners Medical Associates, Samaritan Hospital of Troy, St. Peter's Hospital, St. Joseph's Hospital Health Center, St. Joseph Medical PC. Other: Family Care Medical Group, Crouse Medical Practice, Family Care Medical Group, Mary Imogene Bassett, Little Falls Hospital, Mohawk Valley Health System, Rome Health
Nicole Heldson ✉ Email Address	Counties: Genesse, Livingston, Niagara, Ontario, Orlean, Wyoming, Allegany, Steuben, Chemung	GLIN: Bertrand Chaffee Hospital, Bradford Regional Medical Associates (Upper Allegany Health System), ECMC, General Physicians, Kaleida Health , Niagara Falls Memorial Medical Center, Olean General Hospital, UB Family Medicine INC dba UBMD Primary Care, Wyoming Community Hospital, Paul DeJac, Christopher Beney , Amandeep Pal, Oak Orchard Health, Anthony Jordan, FLH, Geneva Hospital, Finger Lakes Health Center, Soliders and Sailors,Jones Memorial, Jones Memorial, PC. Mt Sinai, Arnot Ogden, Arnot Medical Services.
Nicole Lloyd ✉ Email Address	Cayuga and Jefferson Counties	All Main Street Rural Providers, Auburn Community Hospital
Penny Patterelli ✉ Email Address	Counties: Oneida, Onondaga, Otsego, Schoharie	Trinity Health: St. Peters' Health Partners Medical Associates, Samaritan Hospital of Troy, St. Peter's Hospital, St. Joseph's Hospital Health Center, St. Joseph Medical PC. Other: Family Care Medical Group, Crouse Medical Practice, Family Care Medical Group, Mary Imogene Bassett, Little Falls Hospital, Mohawk Valley Health System, Rome Health
Peter Stone ✉ Email Address	Counties: Broome, Chenango, Delaware, Lewis, Madison; Franklin, Fulton, Hamilton, Herkimer, Montgomery, Saint Lawrence	United Health Services (UHS) Chenango Memorial Hospital INC, Delaware Valley Hospital INC, United Health Services Hospitals, INC, United Medical Associates. Concordia- Oneida Medical Practice PC, Oneida Health Systems INC, Oneida Medical Associates PLLC. Other: Endwell Family Physicians, Lewis County General Hospital, St. Regis Mohawk Tribe, Benardot Tribe, Nathan Littauer Hospital, North County Family, Carondelet, St. Mary's
Robert Chantra ✉ Email Address	Monroe and Wayne Counties	Rochester Regional Health System- (RRHS) Rochester General Hospital, The Unity Hospital of Rochester United Memorial Medical Center, Western New York Medical Practice, Clifton Springs Hospital & Clinic, Newark Wayne Community Hospital (St. Lawrence Health Systems) Massena Hospital, Canton Potsdam Hospital & Medical Practice, Gouverneur Hospital Guthrie Health-Guthrie Corning Hospital, Guthrie Cortland Medical Center, Guthrie Robert Packer Hospital, Guthrie Troy Hospital University of Rochester (U of R) Strong Memorial Hospital

Provider Quality News

Fidelis Care Authorization Grids Effective December 1, 2025

10/31/2025 • Posted by Provider Relations in Provider News

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

The following code has been added to the Medicaid, Medicare, Essential Plan, and Metal-Level Products Authorization Grids and requires prior authorization:

V. Outpatient and DME Services: The following services require prior authorization:

A. Diagnostic testing

6. Proprietary Laboratory Analysis - 0340U

The following code has been added on the Medicaid, Medicare, Essential Plan, and Metal-Level Products Authorization Grids and requires prior authorization:

S0013 esketamine (Spravato)

The following has been updated on the Metal-Level Products Authorization Grid:

The Pharmacy section of the Metal-Level Authorization Grid has been updated to include an indicator for drugs that have a site of care authorization criteria.

In addition to the changes listed above, Fidelis Care would like to share some important updates to our prior authorization requirements effective October 1, 2025. These changes are aligned with broader industry efforts, driven by commitments to regulatory agencies and America’s Health Insurance Plans (AHIP), to modernize and streamline prior authorization.

A full list of code changes that no longer require prior authorization for Fidelis Care, are listed in the charts below:

Medicaid
Code	Description
11900	INJ INTRALES; UP TO & INCL 7 LES
15777	ACELLULAR DERM MATRIX IMPLT
36471	INJ SCLEROSING SOLUTION; MX VEINS SAME LEG
36479	ENDOVENOUS LASER VEIN ADDON
81244	FMR1 GENE CHARACTERIZATION
81331	SNRPN/UBE3A GENE
99601	HOME INFUSION/VISIT, 2 HRS
99602	HOME INFUSION EACH ADDTL HR
A6549	GRADIENT COMP STOCKING/SLEEVE NOS
E0441	STATIONARY O2 CONTENTS, GAS
E0951	HEEL LOOP/HOLDER, WITH OR WITHOUT ANKLE STRAP, EACH
E0952	TOE LOOP/HOLDER, EACH
E0960	WHEELCHAIR/SHOLDER HARNESS/STRAPS/CHEST STRAP/INCL ANY TYPE MNTNG HRDWR
E0961	MNL WC ACCESS WHL LOCK BRAKE
E0973	WHEELCHAIR ADJUSTABLE HEIGHT, DETACH ARMREST, CMPLTD ASSEMBLY
E0978	WHEELCHAIR ACCESSORY, SAFETY BELT/ PELVIC STRAP, EACH
E1392	PORTABLE OXYGEN CONCENTRATOR
E2211	MANUAL WHEELCHAIR ACCESSORY PNEUMATIC PROPULSION TIRE ANY SIZE
E2213	MANUAL WHEELCHAIR ACCESS INSERT FOR PNEUM PROPULSION TIRE REMOVABLE
E2231	SOLID SEAT SUPPORT BASE
E2366	PWR WC ACSS BATTRY CHARGER 1
K0019	ARM PAD REPLACEMENT ONLY EAC
K0038	LEG STRAP EA
K0043	FOOTREST LWR EXT TUBE REPL ONLY EA
K0739	REPAIR/SVC DME NON-OXYGEN EQ
S5501	HOME INFUS TX CATH CARE COMP
S9494	HIT ANTIBIOTIC/ANTIFUNGAL; D
S9500	HIT ANTIBIOTIC/ANTIFUNGAL; Q
S9502	HIT ABX ANTIVIRL/ANTIFUNGAL;

Marketplace
Code	Description
11900	INJ INTRALES; UP TO & INCL 7 LES
36476	ENDOVEN ABLAT TX VEIN EXT RF; 2&>VNS 1 EXT EA
81244	FMR1 GENE CHARACTERIZATION
K0739	REPAIR/SVC DME NON-OXYGEN EQ
S9127	SOCIAL WORK VISIT THE HOME

Medicare
Code	Description
36471	INJ SCLEROSING SOLUTION; MX VEINS SAME LEG
37765	STAB PHLEBECT VV 1 EXT 10-20 INCI
37766	STAB PHLEBECT VV 1 EXT >20 INCI
95805	MX SLEEP LATENCY TEST-MX TRIALS-ASSESS SLEEPINES
E0954	WHEELCHAIR AC FOOT BOX ANY TY EA FT
E0956	WHEELCHAIR/LATERAL TRUNK, HIP SUPPORT, PREFBRCTD, INCL FIXED MNTNG HRDWR
E2209	ACCESSORY, ARM TROUGH, W OR W/OUT HAND SUPPORT, EACH
E2210	WC ACESS BEARINGS ANY TYPE
E2365	PWR WC ACSS U-1 SEALED BATTR
E2366	PWR WC ACSS BATTRY CHARGER 1
E2603	SKN PROTCT WC SEAT WDTH
E2615	PSTN WC BACK CUSHN POSTLAT WIDTH < 22 IN ANY HT
G0156	HHCP-SVS OF AIDE, EA 15 MIN
K0019	ARM PAD REPLACEMENT ONLY EAC
K0052	SWNGAWAY DTACHBLE FTRSTS RPL
K0733	PWR WC 12-24 AMP HR LEAD BAT
K0739	REPAIR/SVC DME NON-OXYGEN EQ

Visit: Authorization Grids

Provider Office Hours

Fidelis Care hosts webinars called “Provider Office Hours” several times each month to share information and answer any of your questions.

Find out more

Provider Satisfaction Survey

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 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.

HEDIS® 2026 Toolkit

Adult Pocket Guide

Pediatric Pocket Guide

Quick Reference Guide