Bienvenidos, Corredores!

Effective January 1, 2026, providers were required to submit an authorization request for Group and Family Therapy services that exceed 30 visits in a calendar year. The concurrent review requirements will include Mental Health Group and Family Therapy, but excludes Substance Use Disorder (SUD) treatment when the provider/service(s) is/are Article 32 licensed, certified, or otherwise authorized.   The following Mental Health services will require concurrent authorization once the initial 30 visits have been completed: Family Psychotherapy - CPT Code 90847 Fidelis Care will have notification & concurrent review requirements for Family Psychoeducation for any requests after the initial 30 visits per calendar

Fidelis Care will host four Provider Office Hours in June 2026. 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 – June 2026   Topic: Timely Access to Care – Access and Availability Standards When:  Thursday, June 11th – 2 PM – 3 PM EST Click here to register*   Topic: Fidelis Care and Wellcare - Quality Programs When:  Wednesday, June 17th – 10

The following section of the Fidelis Care authorization grids has been updated effective June 1, 2026.             The following code has updated been on the Medicaid, CHP, Essential Plan, and Ambetter Metal-Level Plans Authorization Grids and requires prior authorization: Q5111  pegfilgrastim-cbqv (udenyca)   Visit:  Authorization Grids

Fidelis Care would like to inform providers that we are unable to accept calls from Artificial Intelligence (AI) entities or other automated systems to verify claim status, obtain remittance information, or respond to any other inquiries.  Fidelis Care representatives may only engage with a live person to verify PHI and ensure HIPAA compliance.   Providers are also encouraged to use the Fidelis Care Provider Portal to obtain needed information. For more information on the Provider Portal, please visit:  https://www.fideliscare.org/Provider/Provider-Access-Online-Resources   For additional questions, or if we can be of assistance in any way, please contact your Fidelis Care Provider Engagement Account Manager. To identify your

Fidelis Care is continuing efforts to ensure compliance with Electronic Visit Verification (EVV) requirements under the 21st Century Cures Act. As part of this work, Fidelis Care has partnered with HHAeXchange (HHAX), a home care management solutions vendor.  Providers may choose to use HHAX to submit claims; however, the system must be used for EVV. Claims associated with visits that do not have validated EVV may be denied or subject to recovery. What Providers Need to Know HHAX must be used for EVV validation, even if claims are submitted through another method. Visits without validated EVV may result in claim denials