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11/2/2018 • Posted by Provider Relations
Fidelis Care has made changes to our Medicaid Managed Care, Child Health Plus, and HealthierLife Formulary effective in the 4th quarter 2018. Some of the changes relate to quantity limitations, authorization requirements, as well as drugs being removed and added to the formulary. To review the list and the effective dates, download formulary changes.
11/1/2018 • Posted by Provider Relations
Effective December 1, 2018, Fidelis Care is making changes to Medicaid and Child Health Plus vaccine codes regarding age limitations and removal of the authorization requirement. For outpatient place of service (physician or facility claims), please note the following changes:
10/31/2018 • Posted by Provider Relations
Fidelis Care is pleased to inform you that the most recent 2018 QARR Non-Compliance Report has been posted on Provider Access Online (Fidelis’ Provider Portal). This information is indicative of all encounter data on file with Fidelis Care as of 9/17/2018.
10/31/2018 • Posted by Provider Relations
Each year, Fidelis Care reviews our Medicare Advantage products and benefits, with a goal of offering the most competitive plans possible for members. Balancing rising health care costs, providing key benefits important to members, and continuing to serve low-income seniors are the priorities around which our Medicare Advantage plans and benefits are determined for the coming year. For 2019, Fidelis Care will continue to offer Medicare Dual Advantage plans in the four regions (New York City, Albany, Buffalo, and Syracuse) where we are currently operational. These plans are for those who are eligible for Medicare and Medicaid (dual-eligible beneficiaries).
10/24/2018 • 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. Articles included are:
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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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