Provider | Fidelis Care

Welcome, Providers!


LATEST NEWS


Pharmacy Benefit Carve Out Update
5/24/2023 • Posted by Provider Relations

Fidelis Care’s pharmacy benefit for Medicaid Managed Care and HARP was transitioned to NYRx, the New York State Medicaid Pharmacy program on April 1, 2023.

Fidelis Care wants to make you aware that the list of preferred medications under NYRx may differ from Fidelis Care and may require prior authorization. A list of common Fidelis Care preferred medications that may require a prior authorization under NYRx may be found here: Medicaid and Healthier Life Potentially Impacted Medications.

The list of NYRx preferred medications may be found on the Magellan website. (https://newyork.fhsc.com)

If it has been determined that a prior authorization is required for continuity of care, prescribers may contact Magellan's Clinical Call Center at 1-877-309-9493 or fax 1-800-268-2990. The clinical call center is available 24 hours a day, 7 days per week.

Medicaid enrolled prescribers can initiate prior authorization (PA) requests using a web-based application, PAXpress® (https://paxpress.nypa.hidinc.com/)

*Please note: Prior authorization requests through PAXpress® that do not meet clinical criteria will require that prescribers call Magellan Medicaid Administration.

 

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.