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

Important Prior Authorization Updates Effective October 1, 2026

8/31/2026 • 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. Our goal is to reduce administrative burden, simplify submission and approval processes, and facilitate timely access to appropriate, high-quality care.

Code change details are noted in the table below. The 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.

For 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
Behavioral Health	No PA Required for participating providers	Neurobehavioral Status Exam	96116, 96121
DME and Supplies	No PA Required for participating providers	Mobility Services	E0630
		Respiratory Devices and Supplies	E0443
		Wheelchairs	E0954, E0955, E2607, E2608, E2622, E2623, E2624, E2625
		Orthotic and Prosthetic	L1932, L2630, L5000, L5620, L5629, L5631, L5637, L5704, L5920, L5950
Drug Codes	No PA Required CHP members only	Diabetic Drugs and Supplies	A4238
Genetic Analysis	No PA Required for participating providers	Genetic Testing	81161, 81200, 81206, 81207, 81240, 81241, 81242, 81243, 81250, 81251, 81255, 81260, 81279, 81297, 81304, 81319, 81338, 81339, 81400, 81401
Hearing Services	No PA Required for participating providers	Implants and Supplies	L8624
Hearing Services	No PA Required for participating providers	Hearing Aids	V5130, V5160, V5140
Home Services	No PA Required for participating providers	Home Visit	S9211, T1028
Home Services	No PA Required for participating providers	Nursing Services	T1001
Other Medical Services	PA Required	Other Services	T1999
	No PA Required for participating providers	Wound Care	97597
		Dental Care	G0330
		Waiver Services	T2023
		Incontinence Supplies	T4541
Physician Services	PA Required	Diagnostic Testing	91299
Physician Services	No PA Required for participating providers	Diagnostic Testing	91110, 91111, 91112
Sleep Medicine	No PA Required for participating providers	Sleep Studies	95800, 95805, 95806
Surgery Procedures	No PA Required for participating providers	Eye and Ocular Adnexa	67904

Ambetter From Fidelis Care
Service Category	PA Rule	Services	Procedure codes
Anesthesia	PA Required	Anesthesia Services	00170
Genetic Analysis	PA Required	Genetic Testing	0211U, 0345U
Genetic Analysis	No PA Required for participating providers	Genetic Testing	86813, 86817
Home Services	No PA Required for participating providers	Home Visit	S9211, S9213, S9214
Surgery Procedures	PA Required	Tonsil and Adenoid Procedures	42835
Transplant Services	No PA Required for participating providers	Transplant	38208

Medicare
Service Category	PA Rule	Services	Procedure codes
Testing	No PA Required	Psychological Testing/Neuropsychological Testing	96130, 96131, 96132, 96133, 96136, 96137, 96138, 96139, 96146
DME and Supplies	No PA Required	Equipment and Accessories	E0656, E0657
		Orthotic and Prosthetic	L0457, L0650, L1932, L1940, L1960, L2330, L3030
		Respiratory Devices and Supplies	E0470, E0471, E0562
		Supplies and Devices	E0935
		Wheelchairs	E1226, E2310, E2374, E2607, E2608, E2613, E2614, E2615, E2622, E2623, E2624, E2625
DME Services	No PA Required	Wheelchairs	E1032, E1033, E1034
Genetic Analysis	No PA Required	Genetic Testing	88271, 88275, 88280
Home Services	No PA Required	Infusion Services	99601, 99602, S9500
Other Medical Services	PA Required	Wound Care	97605, 97606
Pain Management	No PA Required	Surgery – Nervous System	64566
Physician Services	No PA Required	Diagnostic Testing	91110, 91111, 91112, 91113
Physician Services	No PA Required	Home Visit	99341, 99342, 99344, 99345, 99347, 99348, 99349, 99350
Surgery Procedures	No PA Required	Integumentary Services	14000, 14001, 14020, 14021, 14040, 14041, 14060, 14061, 15100
Surgery Procedures	No PA Required	Musculoskeletal System	29848
Transportation Services	PA Required	Medical Transportation	A0100

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