Wednesday
• Posted by Provider Relations
To help prevent claim denials and payment recoupments, Fidelis Care would like to remind providers of billing requirements for practitioner‑administered drugs (PADs) that are covered under the NYRx pharmacy benefit.
Certain PADs are included on the Medicaid Pharmacy List of Reimbursable Drugs and may be billed directly to NYRx by a pharmacy. When these drugs are obtained through the NYRx Program—or provided at no cost—providers may not submit a medical claim for reimbursement of the drug itself.
Providers may only seek reimbursement for the administration of a no‑cost drug. PADs obtained via NYRx and billed to Fidelis as a medical claim will
Tuesday
• Posted by Provider Relations
Providers, please remember to review content available in Provider Access Online (Fidelis Care's secure Provider Portal) and the rest of this Provider section of the Fidelis Care website. Both locations are excellent resources of information about our programs and services. One example of a resource contained in this site is our Provider Manual. The Provider Manual contains details about our credentialing processes and our member rights and responsibilities statement. It also includes information about the clinical criteria used in utilization management (UM) decision-making, our pharmacy authorization processes, and Fidelis Care's policy statement on how coverage decisions are made.
Other items you will find in
Last Week
• Posted by Provider Relations
We are committed to making it easier for providers to access the information and tools they need to support our members. Based on feedback and ongoing review, we are making several updates to the Provider section of fideliscare.org. These enhancements are designed to simplify navigation, reduce outdated materials, and bring key resources together in one place.
Here’s what’s new:
Streamlined Authorization Information
Authorization content has been consolidated into a single, streamlined web page to reduce confusion and improve clarity.
The updated page now clearly separates:
Delegated Vendor Authorization Programs
Fidelis Care Authorizations
Updated Provider News and Bulletins
Provider News and Bulletins have been combined to improve visibility
Last Week
• Posted by Provider Relations
Fidelis Care is committed to ensuring accurate claims processing and compliance with state and federal requirements. Providers who identify an overpayment may self‑disclose and refund the amount owed by submitting a refund check along with the required documentation.
When a Refund Is Required
If your office identifies an overpayment—whether through internal review, reconciliation, or audit—you may self‑disclose by submitting:
A refund check, and
A completed Provider Claim Refund Form (located on page 91 in the Provider Manual)
Submitting refunds promptly helps ensure accurate member records and supports ongoing compliance.
How to Submit a Refund Check
Refund checks should be mailed to Fidelis Care using the
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