¡Bienvenidos, proveedores!

Fidelis Care will host three Provider Office Hours in August 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 – August 2025   Topic: Fidelis Care – Back to Basics When:  Thursday, August 14th – 12PM – 1PM EST Click here to register*   Topic: Fidelis Care and WellCare Quality Programs When:  Wednesday, August 20th – 10AM – 11AM EST Click

The following section of the Fidelis Care authorization grids have been updated effective September 1, 2025.   The following code has been updated on the Essential Plan and Metal-Level Products Authorization Grids: Durable Medical Equipment/Supplies:                                1.      These DME codes do not require an authorization: A7046                                                       The following codes have been updated on the Medicare Authorization Grid: A.    Durable Medical Equipment/Supplies:            1.      These DME codes do not require an authorization: A4557, A5500, A6530, A7046, E0443, E0730, E0849, E0951, E0955, E0956, E0961, E0971, E0973, E0990, E1392, E2210, E2365, E2601, E2607, E2624, K0001, K0019, K0040, K0195, K0738, L5685              2.       The following orthotic codes

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

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