Welcome, Providers!


 

LATEST NEWS


Medicaid Update Effective January 1, 2023 – Coverage of Applied Behavior Analysis Services
11/16/2022 • Posted by Provider Relations

Effective January 1, 2023, Applied Behavior Analysis (ABA) services provided by Licensed Behavior Analyst (LBA), Certified Behavior Analyst Assistant (CBAA) working under the supervision of LBAs, or other individuals specified under Article 167 of NYS education law, will be included in the Fidelis Care benefit package for eligible children/youth under age 21 with a diagnosis of autism spectrum disorder and/or Rett Syndrome as defined by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5).

ABA Services

Definition of ABA

ABA is the design, implementation, and evaluation of environmental modifications, using behavioral stimuli and consequences, to produce socially significant improvement in human behavior, including the use of direct observation, measurement, and functional analysis of the relationship between environment and behavior.

Impacted Members

For eligible children/youth under age 21 with a diagnosis of autism spectrum disorder and/or Rett Syndrome as defined by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5).

Type of Providers that can render services.

Applied Behavior Analysis (ABA) services provided by Licensed Behavior Analyst (LBA), Certified Behavior Analyst Assistant (CBAA) working under the supervision of LBAs, or other individuals specified under Article 167 of NYS education law, will be included.

Additional information can be found in the October 2022 Medicaid Update.

If you have any further questions, contact your Fidelis Care Provider Relations Specialist or email the NYS Department of Health at: omcmail@health.ny.gov.

 

 

Smiles-that-Shine

 

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.

Provider Access Online

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

Utilization Management (UM)

Find information and links to external vendor authorization programs as well as links to internal Fidelis Care prior authorization resources.

Join Our Network

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