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Fidelis care would like to inform all participating providers that we will be conducting an Access & Availability Survey in the coming weeks. This survey ensures that providers are meeting NYS mandated Access & Availability standards for all Fidelis Care members. The survey will assess: Timeliness of appointment scheduling based on appointment type.  For example: Routine Care Urgent Care Non-Urgent Sick Visit After Hours Availability  Accuracy of provider directory information. This applies to Primary Care Providers, OB/GYNs, Oncologists, and Behavioral Health Providers. Typical reasons for non-compliance include: Appointment scheduling timeframes do not meet state guidelines. Office

As part of New York’s Medicaid Redesign Team (MRT) initiative, the NY 1115 Waiver introduced the Social Care Networks (SCN) Program, a transformative model focused on integrating social care into healthcare delivery. The SCN program encourages partnerships across health and social services to address Medicaid members' diverse needs, such as food insecurity, housing instability, and lack of transportation. Many of these services may become reimbursable to a member under the provision of this waiver.   How the SCN Program Works: Eligible Medicaid, MAP, MLTC, and HARP Members have access to a wide range of free services through the local Social Care Network (SCN),

Fidelis Care would like to inform providers of a postpartum visit incentive being offered through the New York State (NYS) Medicaid program. 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. The incentive payment will apply to postpartum visits for deliveries that occurred from July 1, 2024, through March 31, 2025. 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

CIUDAD DE LONG ISLAND, NY (10 de Junio de 2025) Fidelis Care, un plan de salud estatal con más de 2.4 millones de miembros en el Estado de Nueva York y una empresa de Centene Corporation, ha abierto el proceso de solicitud de su programa de subvenciones de salud materna de 2025. Las subvenciones, abiertas para proveedores de atención médica y organizaciones comunitarias de Nueva York, tienen el objeto de financiar programas que apoyen estrategias innovadoras en atención posparto y salud mental materna. La solicitud está disponible en fideliscare.org/maternal-grant. La fecha límite para presentar la solicitud es el 8 de Julio de 2025 a las 5 p.m.

Fidelis Care would like to remind providers of the appropriate coding modifiers to use when billing for a surgical or diagnostic procedure that was discontinued or stopped prior to completion for both facilities and physicians.    Modifiers 73/74 are specifically used by facilities, to indicate that a procedure was discontinued or stopped prior to completion.  Coinciding with these facility modifiers, physicians should bill modifiers 52/53, which also indicates that a procedure was discontinued or cancelled.  If a procedure has been discontinued, both facility and physician claim submissions should reflect the discontinuation, by using the appropriate modifier codes below.   Facility Modifier Codes: Modifier 73:

The following section of the Fidelis Care authorization grids have been updated effective August 1, 2025.   The following code has been added on the Medicare, Medicaid, Essential Plan, and Metal-Level Products Authorization Grids and require prior authorization: III.       Outpatient surgery: P. CAR-T Therapy: Q2058   Visit:  Authorization Grids