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

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

Provider Quality News

Important Prior Authorization Updates Effective April 1, 2026

2/27/2026 • Posted by Provider Relations in Provider News

As part of our ongoing work to improve the prior authorization (PA) process for both providers and members, Fidelis Care wants to share some important updates to our PA requirements for Medicaid, Ambetter From Fidelis Care and Medicare lines of business. Our goal is to reduce administrative burden, simplify submission and approval processes, and facilitate timely access to appropriate, high-quality care.

Code change details for each line of business can be found below. These changes may include:

· Removing PA requirements based on criticality of review and clinical need.

· Creating a more uniform set of prior authorization requirements across our markets and lines of businesses, including adding and changing some PA requirements, to simplify processes, reduce confusion for providers, and support future efforts to expand real-time responses to requests.

If you have questions about specific prior authorization codes or how these changes affect your practice, please reach out to your local Provider Engagement representative.

Medicaid
Service Category	PA Rule	Services	Procedure codes
Breast Services	No PA Required if billed with breast cancer diagnosis. PA Required if billed with any other diagnosis	Breast Reconstruction	19350, 19364
Breast Services		Surgery-Integumentary System	19303
DME Services	PA Required	Neurostimulators	E0745
		Orthotic & Prosthetic	L0460, L0462
		Supplies and Devices	E1390
		Wheelchairs	E1028, K0826, K0836, K0837, K0838, K0839, K0841, K0843, K0850, K0857, K0858, K0863, K0884
	No PA Required if member is under 21 years old at date of service. PA Required for all other members.	Nutritional Services	B4100
	No PA Required for PAR providers	Neurostimulators	E0730
		Orthotic & Prosthetic	L2330
		Supplies and Devices	E0600
		Wheelchairs	E0950, E0956
Drug Codes	PA Required	Injections	J0485, J0878, J1437, J3240, Q0138, Q0139, Q4081, Q5105
Drug Codes	PA Required	Medications	J0604
Genetic Analysis	PA Required	Genetic Testing	81201, 81292, 81329, 88262, 88271, 88275
Other Medical Services	No PA Required for PAR providers	Wound Care	97605, 97606, 97607, 97608
Pain Management	PA Required	Surgery-Nervous System	62350, 62362
Pain Management	PA Required	Surgery-Nervous System	64445
Physician Services	PA Required	Neurological Tests	95700, 95712, 95713, 95714, 95715, 95716, 95718, 95720, 95721, 95722, 95723, 95724, 95725, 95726
Skin Procedures	PA Required	Muscle Flap Procedures	15736, 15738
	PA Required	Skin Grafts	15271, 15274, 15275, 15276
	No PA Required for PAR providers	Skin Grafts	14060, 14061, 15100, 15101, 15120
	PA Required after 12 visits per calendar year	Surgery-Integumentary System	11043
Surgery Procedures	PA Required	Bariatric Surgery	43644, 43645
		Hysterectomies	58545
		Joint Replacement Surgery	25447, 27702
		Spinal Surgery	22830, 63200
		Surgery-Heart	92920
		Surgery-Musculoskeletal System	28285, 28296
	No PA Required for PAR providers	Hysterectomies	58260, 58262, 58550, 58552, 58553, 58554
	No PA Required for PAR providers	Surgery-Male Genitalia	54520

Ambetter From Fidelis Care
Service Category	PA Rule	Services	Procedure codes
Breast Services	No PA Required if billed with breast cancer diagnosis. PA Required if billed with any other diagnosis	Surgery-Integumentary System	19303
DME Services	No PA Required for PAR providers	Wheelchairs	K0004
Drug Codes	PA Required	Injections	J3240, Q0138, Q0139, Q5105
Genetic Analysis	PA Required	Genetic Testing	0037U
Genetic Analysis	No PA Required for PAR providers	Genetic Testing	81252
Physical Medicine	No PA Required for PAR providers	Orthotic & Prosthetic	L5652
Skin Procedures	PA Required	Muscle Flap Procedures	15734, 15736, 15738
Surgery Procedures	PA Required	Surgery-Musculoskeletal System	25111, 29848

Medicare
Service Category	PA Rule	Services	Procedure codes
DME Services	No PA Required for PAR providers	Beds	E0185
		Orthotic & Prosthetic	L1951
		Supplies and Devices	E0486, K0738
Drug Codes	No PA Required for PAR providers	Medications	J1096
Genetic Analysis	No PA Required for PAR providers	Genetic Testing	81240, 81256
Other Medical Services	No PA Required for PAR providers	Wound Care	E2402
Physical Medicine	No PA Required for PAR providers	Orthotic & Prosthetic	L5629, L5637
Physician Services	No PA Required for PAR providers	Other Services	99499, G3002
Skin Procedures	PA Required	Muscle Flap Procedures	15734, 15736, 15738
Skin Procedures	No PA Required for PAR providers	Surgery-Integumentary System	11721, 17000, 17250
Surgery Procedures	No PA Required for PAR providers	Surgery-Nervous System	64718, 64719
Vision Services	No PA Required for PAR providers	Vision Evaluation	92004, 92201, 92250

Provider Office Hours

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

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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 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.

HEDIS® 2025 Toolkit

Adult Pocket Guide

Pediatric Pocket Guide

Quick Reference Guide