¡Bienvenidos, proveedores!

Fidelis Care will host three Provider Office Hours in November 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 – November 2025   Topic: Fidelis Care – Back to Basics When:  Thursday, November 13th – 9AM – 10AM EST Click here to register*   Topic: Fidelis Care and Wellcare - Quality Programs When:  Wednesday, November 19th – 10 AM – 11 AM EST

As we approach the final quarter of the year, we’re entering a critical phase of the Continuity of Care (CoC) program. Our shared goal remains clear: to ensure patients receive timely, high-quality care while closing the most impactful clinical gaps by December 31. To support you in this effort, we’ve refined the appointment agenda to focus on the most urgent and actionable opportunities with a particular emphasis on risk adjustment conditions. This streamlined approach is designed to: Prioritize the highest-value clinical care gaps for closure; Maximize your time during each patient encounter to focus on the more critical clinical and

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 would like to remind providers of a postpartum visit incentive being offered through the New York State (NYS) Medicaid program and inform providers of extended claim submission dates. This program will provide an additional payment to the current NYS Medicaid reimbursement for comprehensive, timely postpartum visits provided to Medicaid Managed Care (MMC)/Fidelis Care Medicaid members. Providers who delivered a person-centered comprehensive postpartum visit as outlined by the American College of Obstetricians and Gynecologists clinical guidelines, including a postpartum depression screen, to Fidelis Care members within 12 weeks of the date of delivery will receive an additional payment of $208.55. 

Fidelis Care is partnering with Healthmap Solutions (Healthmap) to provide care coordination services within our kidney health management (KHM) program. As a leading national kidney health management company, the partnership with Healthmap will provide more comprehensive care for Medicaid, HARP, CHP, and Wellcare By Fidelis Care Medicare and Dual Advantage members, with chronic kidney disease (CKD) stages 3, 4, 5, and end stage renal disease (ESRD). If you have a patient with kidney disease, or chronic conditions that may lead to kidney disease, Healthmap may contact you to facilitate care. Healthmap provides collaborative recommendations through workflow-friendly clinical decision support. Healthmap’s KHM program

Effective November 1, 2025, Fidelis Care will begin outreaching for additional clinical information if a member remains hospitalized beyond seven (7) days. This outreach will initiate a concurrent review to assess medical necessity and support discharge planning activities. Please note the following important updates: Initial approvals for emergent admissions and some elective admissions will no longer reflect a 30-day authorization period. Instead, ongoing hospitalization beyond 7 days will require submission of updated clinical documentation to support continued stay. Fidelis Care already conducts outreach for additional clinical information in cases where a member remains hospitalized for greater than 30 days. This new