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Fidelis Care would like to notify providers that the MCG Cite Guideline Transparency Tool was upgraded to the 29th edition effective Saturday, April 26, 2025. Providers can access this tool through the Fidelis Care Provider Portal. Highlights of the changes in the 29th edition of the MCG care guidelines include: Five new observation care guidelines in MCG Inpatient & Surgical Care to support the use of observation care for specific diagnoses. In addition, a new calculator for mean arterial pressure (MAP) was added to the content (where applicable). A new “Gene and Cellular Therapy” section containing guidelines for cutting-edge treatments was added

Fidelis Care is pleased to announce that providers will soon have access to correct and resubmit a paid or denied claim, and view and reconcile remittances through their Availity Essentials account.   On April 21, Fidelis Care providers will have the following new functionality available on Availity Essentials. Claim Corrections - Correct and resubmit a paid or denied claim from the Claim Status Response page. Ask your Availity Essentials Administrator to assign you the Claim Status role if this task is appropriate for your role.   Remittance Viewer - Locate remittances with ease using the extensive search and filter options. You can

Fidelis Care would like to inform providers of updated requirements with the NYS Recipient Restriction Program. The goal of the Recipient Restriction Program (RRP) is to coordinate medical and/or pharmacy services and improve the quality of care for Medicaid recipients. Coordination of care reduces the potential over-utilization of health care services, prevents abusive or fraudulent behavior, and protects Medicaid recipients’ health and safety.   As of February 24, 2025, a restricted recipient must comply with the Recipient Restriction Program. If restricted to a pharmacy, the restricted recipient will be required to fill prescriptions at their designated pharmacy. Claims will not pay if

Fidelis Care will host three Provider Office Hours in April 2025. During the webinars, Fidelis Care staff will be available to share information, provide an overview of provider resources, and answer your questions. Provider Office Hours – April 2025 Topic: Fidelis Care – Back to Basics When:  Thursday, April 10th – 12PM – 1PM EST Click here to register*   Topic: Fidelis Care - Credentialing and Data Maintenance Overview When:  Thursday, April 24th – 2PM – 3PM EST Click here

Doctors play an important role in keeping people healthy. They provide expert care, guidance, and compassion to patients every day. In honor of National Doctors’ Day, Fidelis Care thanks doctors everywhere who make a difference in our communities. We visited with doctors from provider partners Compassionate Family Medicine in Syracuse, Polaris Healthcare Visiting Docs in Spring Valley, and WNY Medical in Buffalo to get their thoughts in observance of National Doctors’ Day.   Fidelis Care: What inspired you to become a doctor?   Dr. Riffat Sadiq, WNY Medical: From a young age, I enjoyed helping people to take care of themselves. I had my

The following section of the Fidelis Care authorization grids have been updated effective May 1, 2025.   The following codes have been updated on the Medicare, Medicaid, Essential Plan, and Ambetter Metal-Level Products Authorization Grids and require prior authorization: III.       Outpatient surgery: The following services require prior authorization:            D.  Skin surgery and other dermatological procedures: 11730  requires an authorization when billed with REV codes 0360, 0361 and 0490 Only the following codes require authorization for any place of service: A2030, A2031, A2032, A2033, A2034, A2035, 11200, 11201, 11719, 15769 - 15829, 17340-17999, Q4354, Q4355, Q4356, Q4357, Q4358, Q4359, Q4360, Q4361, Q4362, Q4363, Q4364,