Bienvenidos, Corredores!

In today’s healthcare landscape, effective coordination between primary care providers (PCPs) and specialists is essential for delivering safe, timely, and patient-centered care. When providers collaborate, patients benefit from accurate diagnoses, appropriate treatments, and a smoother care experience. Why It Matters PCPs manage preventive care and chronic conditions, serving as the first point of contact for members. When specialized care is needed, such as for heart disease or skin conditions, specialists become key partners. Without coordination, patients may face delays, conflicting advice, medication errors, and increased healthcare costs. Referrals: A Vital Link Referrals are more than administrative steps; they ensure patients receive the right care

The role of primary care providers in preventing vaccine-preventable diseases includes more than administering vaccines. Timely documentation in New York’s immunization registries (New York State Immunization Information System (NYSIIS) for providers outside New York City, and the Citywide Immunization Registry (CIR) for providers within New York City) is essential to protecting children and supporting public health. Why Timely Reporting Matters Accurate updates to NYSIIS and CIR: Ensure continuity of care Prevent missed or duplicate vaccinations Support public health surveillance Improve office efficiency Comply with New York State law (reporting required within 14 days) The Value of Timely Vaccination Vaccines are most effective when given

Fidelis Care’s Pharmacy Services would like to provide clarification on how medications are covered under member’s medical and pharmacy benefits.   Medications Covered Under Fidelis Care Medical Benefit Physician Administered Drugs – medications administered to a member during an outpatient visit Providers obtain medication via “buy-and-bill” or shipment to their practice site from a vendor of their choosing. Coverage is dictated by Fidelis Care Authorization Grids, Prior Authorization Lookup Tool and/or Evolent Specialty Services (formerly NCH) Authorization Grids (Oncology Regimen Specific). Medical Benefit Authorization Grids are plan specific. If a medication is listed on one of the above authorization grids/tools, an authorization

Fidelis Care will host three Provider Office Hours in October 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 – October 2025   Topic: Fidelis Care Tools & Resources Overview When:  Thursday, October 9th – 12PM – 1PM EST Click here to register*   Topic: Fidelis Care and Wellcare - Quality Programs When:  Wednesday, October 15th – 10 AM – 11 AM EST

The following sections of the Fidelis Care authorization grids have been updated effective October 1, 2025.             The following codes have been updated on the Medicaid, CHP, Essential Plan, Ambetter Metal-Level Plans, and Medicare Authorization Grids and require prior authorization: C9305      nipocalimab-aahu (Imaavy) C9306      telisotuzumab vedotin-tllv (Emrelis) J0614      treosulfan (Grafapex) J1370      esomeprazole injection J1809      fosdenopterin J3402      remestemcel-l-rknd (Ryoncil) J3403      Revakinagene taroretcel-lwey (Encelto) J7173      concizumab-mtci (Alhemo) J7174      fitusiran (Qflitlia) J9011      datopotamab deruxtecan-dlnk (Datroway) Q5154     omalizumab-igec (Omlyclo) Q5155     aflibercept-jbvf (Yesafili) Q5156     tocilizumab-anoh (Avtozma) Q5157     denosumab-bmwo (Stoboclo/Osenvelt) Q5158     denosumab-bnht (Bomyntra/Conexxence) Q5159     denosumab-dssb (Ospomyv/Xbryk)   For Medicaid, CHP, Essential Plan, Ambetter Metal-Level Plans, and Medicare, the following codes have been added to the list of drugs that require NCH review: J9011      datopotamab deruxtecan-dlnk (Datroway) Q5156     tocilizumab-anoh (Avtozma) Q5157     denosumab-bmwo (Stoboclo/Osenvelt) Q5158     denosumab-bnht (Bomyntra/Conexxence) Q5159     denosumab-dssb (Ospomyv/Xbryk)   Visit: