Fidelis Care is pleased to inform you that the medical record request letter and details for 2021MY HEDIS/QARR have been posted on our Provider Portal, Provider Access Online (PAO). Please review these materials and send the requested documentation to Fidelis Care or arrange for us to retrieve the records from your office as soon as possible.
Please notify any staff involved with Quality Management that these documents have been posted on PAO. If you have any questions, please call the Provider Call Center at 1-888-FIDELIS (1-888-343-3547).
Please note that your office will receive a separate notice for Wellcare HEDIS medical record requests,
As recommended in New York State Department of Financial Services Insurance Circular Letter No. 1 dated January 6, 2022, Fidelis Care has suspended the following prior authorization requirements for Medicare products:
Hospital to Hospital transfer between participating facilities
The hospital is expected to use its best efforts to provide notice to Fidelis Care within 48 hours of the transfer.
Please include information necessary for Fidelis Care to assist in coordinating care and discharge planning.
Skilled Nursing Facilities (SNF)
Providers will have up to 5 days to notify Fidelis Care of the admission.
Fidelis Care will approve the first 5 days of
Fidelis Care has planned enhancements to our secure Provider Access Online that may impact some users. At the provider portal login screen, users may have opted to have their username “autofill” by enabling the browser to remember previous account sign-ins. To protect the security of member data, the autofill function on the login screen of Provider Access Online will no longer be supported beginning in February 2022.
Please ensure you can recall or have safely stored active usernames you are utilizing to access the secure provider portal in order to avoid any issues logging in following the portal update.
The following sections of the Fidelis Care authorization grids have been updated effective February 1, 2022.
The Medicaid Authorization Grid has been updated as follows:
IV. Behavioral Health - Outpatient services
Personalized Recovery Oriented Services (PROS): Effective February 1, 2022, Prior authorization is not required for Personalized Recovery Oriented Services (PROS). Prior to this date, prior authorization was required.
Home and Community Based Services (HCBS) are available if determined to be eligible through enrollment in the adult HealthierLife plan and in conjunction with a completed evidence based eligibility assessment. The intake period (3 visits or 14 days) do not require prior
The Centers for Medicare and Medicaid (CMS) have released several billing changes and updates for various Medicare services that take effect on January 1, 2022. As a valued Wellcare By Fidelis Care provider partner, we want to make you aware of how these changes will impact your billing activities with us in 2022.
COVID-19 Vaccination Claims
Effective January 1, 2022, providers may submit Medicare claims for COVID-19 vaccines and their administration directly to Wellcare By Fidelis Care for payment.
Previously, COVID-19 vaccination claims were submitted directly to Medicare Fee-for-Service. For dates of service 1/1/22 and after, Wellcare By Fidelis Care will