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Fidelis Care has received notice from the Office of the Medicaid Inspector General (OMIG) of new compliance program requirements for Medicaid participating providers. Effective April 2020, for New York State (NYS) Social Services Law (SSL) §363-d, and effective December 28, 2022, for the corresponding regulations at 18 New York Codes, Rules and Regulations (NYCRR) Subpart 521-1, NYS Medicaid providers shall adopt, implement, and maintain effective compliance programs aimed at detecting fraud, waste, and abuse in the NYS Medicaid program.   Who is Required to Have a Compliance Program? NYS Social Services Law (SOS) § 363-d and Title 18 of the New York Codes, Rules

Annual cultural competency training for participating providers is required by the New York State Department of Health.  At this time, The New York State DOH will only accept the approved training offered by the United States Department of Health and Human Services (HHS), Office of Minority Health education program, Think Cultural Health, to fulfill the requirement for provider annual cultural competency training.*   Once the cultural competency training has been completed, providers need to verify completion of the program by emailing the Cultural Competency Attestation Form to: CulturalCompetencyTrainingAttestation@fideliscare.org.   The required Cultural Competency Training needs to be completed annually by December 31st. Providers that completed

Fidelis Care would like to remind providers that Urgent and Concurrent Authorization Requests cannot be submitted through the Provider Portal, as this will cause delays in processing.   To expedite the processing of Urgent, providers should submit requests through: Availity Essentials, or Fax Urgent requests directly to: (800) 860-8720, and label the request as “Urgent”   Urgent Concurrent Authorization Requests and Concurrent Authorization Requests should be submitted by: Faxing requests directly to: (800) 860-8720, and labeling the request as “Concurrent”   To register for an Availity Essentials account, visit Register and Get Started with Availity Essentials.   For additional questions, or if we can be of assistance in any

In an effort to streamline provider demographic changes and provider termination requests, Fidelis Care has created two new electronic forms for providers to use.  Please use these forms to submit changes under a singular TIN. In order to expedite the request, all fields on the forms are required. If not complete, the request will be delayed. Forms available on fideliscare.org: Provider Demographic Change Request Form   Provider Termination Request Form   Once completed, the forms can be submitted electronically to SMProviderAttestationUpdates@fideliscare.org. In the subject line of the email, please enter Demographic Change/Termination Request for "Your Provider/Group Name" in "Your County" (i.e. Demographic Change Request

Access to quality care is important to eliminate health disparities and increase the quality and years of healthy life for all New Yorkers. The NYSDOH requires that certain Access and Availability Standards be met by PCPs, OB/GYNs, specialists, and behavioral health providers where applicable. Click here to view the full list of standards, including situations and timeframes.   For additional questions, or if we can be of assistance in any way, please contact your Fidelis Care Provider Engagement Account Manager. To find your designated representative, please click here. 

Fidelis Care received notice from New York State Office of Addiction Services and Support (OASAS), that providers are required to bill OTP bundle services under the APG methodology effective November 3, 2025. This applies to Medicaid Managed Care (MMC) plans, including Mainstream MMC plans, HIV Special Needs Plans (HIV SNPs), and Health and Recovery Plans (HARPs). Initiative Timeline: Beginning July 1, 2024, providers were given the option to bill OTP bundle services either under the existing OTP bundle rate codes or the APG methodology.  The May memorandum also indicated that OASAS would zero out the bundle rate codes (7969-7976) after a