Provider | Fidelis Care
Member
Providers
Shop For a Plan

Welcome, Providers!


LATEST NEWS


Payment Reductions on Elective Delivery (C-Section and Induction of Labor) Less than 39 Weeks without Medical Indication
3/9/2020 • Posted by Provider Relations

As a reminder, Fidelis Care will reduce payment for early elective deliveries without an acceptable medical indication. Claims for elective deliveries prior to 39 weeks, without medical indication, will be reduced as per New York State Medicaid policy. The penalty reflects the Medicaid Program's commitment to providing high quality prenatal care by ensuring appropriate delivery for both mothers and babies.  The penalty amount will be a reimbursement rate of 25% of the C-section fee schedule allowed amount.

Additionally, for medical claims modifiers U7, U8 or U9 will continue to be required for all deliveries and claims for hospital inpatient stays associated with a delivery will continue to require a condition code 81, 82 or 83 for payment.  Failure to include the appropriate modifiers and/or condition codes will result in claim denials.

For further information, refer to our provider manual, Section 12 – Part 2, starting on page 12.2.6 Obstetric Delivery Billing Requirements  

 

Smiles-that-Shine

Provider Access Online

Verify member eligibility or renewal status, check claims, send e-scripts, and more.

Member Renewal Information

Health insurance will no longer be automatically renewed for Medicaid Managed Care, Essential Plan, Child Health Plus, or HealthierLife members.

Join Our Network

Apply to our network and become a part of the Fidelis Care mission. 

 

 

 

Required Cultural Competency Training

Access the Provider Attestation Statement and submit completion of training.

Authorization Resources

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

Electronic Transactions

Submit claims electronically for faster processing and reimbursement.

Utilization Management (UM)

Find information and links to external vendor authorizations and to internal resources.