El blog de Fidelis Care

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 Medications that are administered to a member during an outpatient visit are covered under the member’s medical benefit.  The authorization requests and claims for these medications should be processed through Fidelis Care using the guidelines and tips below, for all Lines of Business. 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.

Fidelis Care would like to notify our providers of an update to our Children and Family Treatment and Support Services (CFTSS) Utilization Review Process.  Effective July 1, 2025, Fidelis Care will begin Utilization Management on certain CFTSS Services with a service date of July 1, 2025 or later. Services rendered and billed through June 30, 2025, will process with no authorization requirements.   Fidelis Care will require notification of the initiation of CFTSS Services, and provider must request prior authorization after the 3rd Visit for the following services. Other Licensed Practitioner (OLP) Community Psychiatric Supports and Treatment (CPST) Psychosocial Rehabilitation (PSR) Family

The following section of the Fidelis Care authorization grids have been updated effective July 1, 2025.   The following DME codes have been removed from the Medicaid, Essential Plan, and Ambetter Metal-Level Products Authorization Grids and no longer require prior authorization: K0001  Standard wheelchair L0621  SIO flex pelvisacral prefab L2630  Pelvic control band and belt B L3809 Whfo w/o joints pre ots   The following code has been updated on the Medicaid, Essential Plan, and Ambetter Metal-Level Plans Authorization Grids and requires prior authorization: Q0224   pemivibart (Pemgarda)   The following codes have been updated on the Medicare, Medicaid, Essential Plan, and Ambetter Metal-Level Plans Authorization Grids and require prior authorization: C9174   datopotamab deruxtecan-dlnk

Para promover la salud y el bienestar de la comunidad y la importancia de mantener la conexión con amigos y vecinos, Fidelis Care anunció las fechas de su serie anual de festivales callejeros de Unity. Comenzando con el evento original “Unity in the Heights” de 2011, la serie se amplió por todo el estado con una variedad de socios locales.

  As a first-generation immigrant from China, I have lived in the beautiful United States for 24 years. For 18 of those years, my stethoscope has touched the heartbeat of New York City where nearly 15 percent of its population is of Asian heritage. Like many New Yorkers, we are blessed to be both observers of and participants in the development of our community. Each May, in observance of Asian American and Pacific Islander (AAPI) Heritage Month, I am encouraged to ask, "Who am I? What have I built? What is left to heal?" The 2025 AAPI Heritage Month theme is “A Legacy of Leadership and Resilience.” This