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LATEST NEWS


Thursday • Posted by Provider Relations
Fidelis Care is pleased to announce that a new Provider Bulletin is now available. The bulletin features updates on important initiatives and the latest news of interest to our provider community.
4/3/2019 • Posted by Provider Relations
Fidelis Care is pleased to inform you that the most recent 2019 QARR Non-Compliance Report has been posted on Provider Access Online (provider portal). This information is indicative of all encounter data on file with Fidelis Care as of 02/18/2019.
3/26/2019 • Posted by Provider Relations
As a reminder, the Centers for Medicare and Medicaid Services (CMS) guidelines indicate that claims billed for physical, occupational, and speech therapy services must be submitted with the appropriate modifier.
3/25/2019 • Posted by Provider Relations
Fidelis Care is pleased to inform you that the medical record second request letter and details for 2019 HEDIS/QARR have been posted on our Provider Portal, Provider Access Online (PAO). Please review these materials and send the requested documentation to Fidelis Care as soon as possible.
3/22/2019 • Posted by Provider Relations
The purpose of this ALERT is to inform Providers that the way in which certain Medicaid members renew their coverage is changing. Medicaid MAGI individuals (eligible recipients through the Modified Adjusted Gross Income rules) may now need to renew their coverage through the NYSOH Marketplace rather than through the local Department of Social Services/ Welfare Management System (WMS.) Due to the large number of MAGI enrollees, the transition to NY State of Health Marketplace has been occurring in phases. The next phase of the transition will affect enrollees with a coverage end date of April 30, 2019. This will include Medicaid HARP (Health and Recovery Program) individuals who reside in all NY State counties, except for the five boroughs of NYC (Bronx, Kings, Manhattan, Queens, and Staten Island.)
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Important Information on Coverage Decisions

Each day, Fidelis Care's Utilization Management (UM) Department makes decisions on numerous health insurance claims. These decisions are based only on appropriateness of care and the existence of coverage. 

Fidelis Care does not reward practitioners or other individuals for issuing denials of coverage, and does not offer financial incentives to UM staff that would encourage decisions that result in underutilization of services. 

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