4/4/2025
• Posted by Provider Relations
• in
Provider News
The Fidelis Care Provider Relations Department is committed to building strong and lasting relationships with our providers and their staff. To foster this partnership, we have assigned a Provider Relations Specialist to communicate important information and provide support to our providers.
Please be sure to reference our Contact Your Designated Provider Relations Specialist web page if you do not know the name of the specialist assigned to your provider group. To note, there are times that we adjust territory assignments to better serve our providers, so it important to periodically verify your assigned specialist.
If you are unable to determine the identity
3/31/2025
• Posted by Provider Relations
• in
Provider News
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
3/31/2025
• Posted by Provider Relations
• in
Provider News,
Provider Quality
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
3/28/2025
• Posted by Fidelis Care
• in
In The Community,
Provider News
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
3/27/2025
• Posted by Provider Relations
• in
Provider News
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,
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