Welcome, Providers!

In accordance with Chapter 645 of the Laws of 2005, the New York State (NYS) Medicaid program does not cover prescription or physician-administered drugs used for the treatment of sexual dysfunction (SD) or erectile dysfunction (ED).

Fidelis Care would like to remind our provider community of the required protocols for submitting corrected claims and to clarify how these differ from appeals. Following these guidelines helps ensure timely and accurate claims processing.

Fidelis Care is committed to strengthening our partnership with providers and enhancing the overall experience when addressing claims related concerns. As part of this ongoing effort, we are introducing a new Fidelis Care Claims Inquiry Template, which will be required beginning March 1, 2026 for all claims inquiries submitted after the standard appeals process has been completed.

The New York State (NYS) Department of Health has applied to participate in the federal Centers for Medicare and Medicaid Services (CMS) Cell and Gene Therapy (CGT) Access model.

Fidelis Care would like to inform providers that evaluation and management (E&M) services billed on a facility claim with treatment room revenue codes are not eligible for reimbursement. Evaluation and Management procedure codes represent the professional service – the physician or qualified provider’s time, assessment and decision- making.

Fidelis Care is pleased to announce the release of our 2025 Community Impact Report, a comprehensive look at how we worked together to make a difference in communities across New York State.