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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


Updated Evolent Authorization Requirements Effective July 1, 2026
5/28/2026 • Posted by Provider Relations in Provider News

Effective July 1, 2026, the following procedures will be removed from prior authorization.

 

The following RADIOLOGY AND DIAGNOSTIC CARDIOLOGY (RBM) codes have been removed from the Evolent’s Utilization Review Matrix and no longer require prior authorization for Medicaid.

 

Modality

Impacted CPT

CT ORBIT/EAR/FOSSA WITH O DYE

70480,70481,70482

CT MAXLOFCE AREA; W/O CONTRAST MATL

70487,70488, 70486, 76380

DIAGNOSTIC COMPUTED TOMOGRAPHY THORAX W/O CNTRST

71250, 71260, 71270, 71271

CT UPPER EXTREMITY WITH O DYE

73200, 73201, 73202

MRI UPPR EXTREMITY WITH OAND WITH DYE

73218, 73219, 73220

CT LOWER EXTREMITY WITH O DYE

73700, 73701, 73702

MRI FETAL SNGL/1ST GESTATION

74712, 74713

CARDIAC MRI MORPHOLOGY & FUNCTION W/O CONTRAST

75557, 75559, 75561, 75563

CT HRT WITH 3D IMAGE CONGEN

75573

MRI BREAST WITHOUT CONTRAST MATERIAL UNILATERAL

77046, 77047, 77048, 77049

CT BONE MINERL DENSITY STUDY 1/> SITS AXIAL SKE

77078

MRI BONE MARROW BLOOD SUPPLY

77084

GATED HEART PLANAR SINGLE

78472, 78473, 78494

ECHOCRDGRPHY RL TM W/2D W/WO M-MODE, TRANSESOPHAGEAL

93312, 93313, 93314, 93315, 93316, 93317, 93318

 

The following RADIOLOGY AND DIAGNOSTIC CARDIOLOGY (RBM) codes have been removed from the Evolent’s Utilization Review Matrix and no longer require prior authorization for Medicare.

 

Modality

Impacted CPT

CT ORBIT/EAR/FOSSA WITH O DYE

70480,70481,70482

CT MAXLOFCE AREA; W/O CONTRAST MATL

70487,70488, 70486, 76380

CT SOFT TISSUE NECK WITH O DYE

70490, 70491, 70492

MRI IMAGING BRAIN; INCLUDING BRAIN STEM; WITHOUT CONTRAST MATERIAL

70551, 70552, 70553

MRI- SPINAL CANAL AND CONTENTS, CERVICAL; WITHOUT CONTRAST MATERIAL

72141, 72142, 72156

MRI, SPINAL CANAL AND CONTENTS, THORACIC; WITHOUT CONTRAST MATERIAL

72146, 72147, 72157

MRI- SPINAL CANAL AND CONTENTS, LUMBAR; WITHOUT CONTRAST MATERIAL

72148, 72149, 72158

MRI PELVIS WITH DYE

72195, 72196, 72197

CT UPPER EXTREMITY WITH O DYE

73200, 73201, 73202

MRI UPPR EXTREMITY WITH OAND WITH DYE

73218, 73219, 73220

MRI JOINT UPR EXTREM WITH O DYE

73221, 73222, 73223

CT LOWER EXTREMITY WITH O DYE

73700, 73701, 73702

CT ABDOMEN WITH O DYE

74150, 74160, 74170

MRI ABDOMEN WITH O DYE

74181, 74182, 74183, S8037

MRI FETAL SNGL/1ST GESTATION

74712, 74713

CARDIAC MRI MORPHOLOGY & FUNCTION W/O CONTRAST

75557, 75559, 75561, 75563

CT HRT WITH 3D IMAGE

75572

CTA HRT CORNRY ART/BYPASS GRFTS CONTRST 3D POST

75574

MRI BREAST WITHOUT CONTRAST MATERIAL UNILATERAL

77046, 77047, 77048, 77049

CT BONE MINERL DENSITY STUDY 1/> SITS AXIAL SKE

77078

MRI BONE MARROW BLOOD SUPPLY

77084

GATED HEART PLANAR SINGLE

78472, 78473, 78494

ECHOCRDGRPHY RL TM W/2D W/WO M-MODE, TRANSESOPHAGEAL

93312, 93313, 93314, 93315, 93316, 93317, 93318

 

The following RADIOLOGY AND DIAGNOSTIC CARDIOLOGY (RBM) codes have been removed from the Evolent’s Utilization Review Matrix and no longer require prior authorization for Ambetter From Fidelis Care and Essential Plans.

 

Modality

Impacted CPT

CT ORBIT/EAR/FOSSA WITH O DYE

70480,70481,70482

CT MAXLOFCE AREA; W/O CONTRAST MATL

70487,70488, 70486, 76380

DIAGNOSTIC COMPUTED TOMOGRAPHY THORAX W/O CNTRST

71250, 71260, 71270, 71271

MRI PELVIS WITH DYE

72195, 72196, 72197

CT UPPER EXTREMITY WITH O DYE

73200, 73201, 73202

MRI UPPR EXTREMITY WITH OAND WITH DYE

73218, 73219, 73220

CT LOWER EXTREMITY WITH O DYE

73700, 73701, 73702

MRI FETAL SNGL/1ST GESTATION

74712, 74713

CARDIAC MRI MORPHOLOGY & FUNCTION W/O CONTRAST

75557, 75559, 75561, 75563

CT BONE MINERL DENSITY STUDY 1/> SITS AXIAL SKE

77078

GATED HEART PLANAR SINGLE

78472, 78473, 78494

ECHOCRDGRPHY RL TM W/2D W/WO M-MODE, TRANSESOPHAGEAL

93312, 93313, 93314, 93315, 93316, 93317, 93318

 

 

Provider Office Hours

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

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.


Resources

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

Provider Tip Sheets - Quality

Quality

Adult Wellness Visit Tip Sheet

Behavioral Health Case Management Services Tip Sheet

Behavioral Health Follow-Up Measures

Breast Cancer Screening Tip Sheet

Child and Adolescent Well Care Visits Tip Sheet

Childhood Immunization Status Tip Sheet

Closing the Gap on Follow-Up Care After Discharge

Colorectal Cancer Screening Tip Sheet

Continuity of Care Tip Sheet

Controlling High Blood Pressure Tip Sheet

Depression Screening and Follow-Up for Adolescents and Adults

Flu Shot for Adults Tip Sheet

Follow-up Care for Children Prescribed ADHD Medication (ADD) Tip Sheet

Glycemic Status Assessment for Patients with Diabetes (GSD) Tip Sheet

HEDIS® Tip Sheet 2021 Antidepressant Medication Management (AMM)

HEDIS® Immunizations for Adolescents Combination 2 (IMA-2)

Importance of Chlamydia Screening Tip Sheet

Importance of Follow-Up Care for Mental Illness

Improving Cardiometabolic Health for Members with Diabetes Tip Sheet

Kidney Health Evaluation for Patients with Diabetes (KED) Tip Sheet

Low Back Pain Tip Sheet

Metabolic Monitoring for Children and Adolescents on Antipsychotics Tip Sheet

Patient Satisfaction Surveys Tip Sheet

Postpartum Depression Screening and Follow-up Tip Sheet

Preventive Cancer Screenings and Vaccines Tip Sheet

Primary Care Provider (PCP) Quality Tip Sheet

Psychiatric Collaborative Care Model

Smoking Cessation Provider Tip Sheet

Telehealth Guide for Health Home Care Managers

Telehealth Tip Sheet

Transitions of Care (TRC) Tip Sheet

Viral Load Suppression Tip Sheet

Well Child - Birth to 30 Months Well Care Visits Tip Sheet

Wellcare Partnership for Quality Program - 2026

Quality Policies

 

Latest Provider Bulletin

 


Provider Bulletin Archives ➔


Fidelis-Care-Summer-Health-Newsletter