Welcome, Providers!



8/7/2020 • Posted by Provider Relations
Fidelis Care may authorize requests for Avastin, Herceptin, and Xolair when appropriate criteria are met for the Child Health Plus (CHP), Medicaid Managed Care, HealthierLife (HARP), Health Exchange, and Essential Plan lines of business.
8/7/2020 • Posted by Provider Relations
On August 5th, The New York State Department of Financial Services (DFS) posted Circular Letter #14 regarding Charges for Personal Protective Equipment (PPE) by Participating Providers.
7/31/2020 • Posted by Provider Relations
Fidelis Care is pleased to inform you that the most recent 2020 QARR Non-Compliance Report has been posted on Provider Access Online (provider portal).
7/27/2020 • Posted by Fidelis Care
The New York State PTA and Fidelis Care are joining together to launch Every Child Healthy, a new initiative designed to provide health and wellness resources to children and families throughout the summer, and as they prepare for a new school year in the fall...
7/23/2020 • Posted by Provider Relations
If you have not yet done so, please submit your Fidelis Care Medicaid charts for review. Fidelis Care is required by the New York State Department of Health to submit complete diagnostic data for Medicaid members for Risk Adjustment. To help us obtain the necessary medical records for submission, we have partnered with Optum and CiOX Health.
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Authorization Resources

To submit prior authorization request types, use the Fidelis Care provider portal.

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Important Information on Coverage Decisions

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

Fidelis Care does not reward providers or other individuals for issuing denials of coverage, and does not offer financial incentives to UM staff based on decisions that promote underutilization of services. 

Fidelis Care is committed to ensuring that members have the care and services they need. 

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Utilization management systems available to submit authorization requests.