¡Bienvenidos, proveedores!

Fidelis Care would like to share important information pertaining to claim submissions for the new Essential Plan 200-250 plan.     A significant number of members who are now covered under the new Essential Plan 200-250, previously had coverage under an Ambetter from Fidelis Care marketplace plan.  In many cases, the transition to the Essential plan created new subscriber IDs.    In order to support timely and accurate claims processing, please be sure that claims with dates of service 4/1/2024 and later are submitted under the member’s most current Essential Plan member ID.  Any claims for dates of service prior to 4/1/2024 must be

Fidelis Care is pleased to inform you that the most recent 2024 QARR/HEDIS Care Gap Report has been posted on Provider Access Online (provider portal). This information is indicative of all encounter data on file with Fidelis Care as of 02/19/2024.  This report provides you with the opportunity to review preventative services for which Fidelis does not show your members as receiving in the measurement period.  We strongly suggest that you review the report for opportunities to either render the service, schedule the service to be done before 12/31/24 or if previously performed, submit supplemental data by 2/1/25.  Please notify

Fidelis Care’s Pharmacy Services would like to provide further clarification on how medications are covered under member’s medical and pharmacy benefits.   Medications Covered Under Fidelis Care Medical Benefit Physician Administered Drugs – medications administered to a member during the course of an outpatient visit Providers obtain medication via “buy-and-bill” or shipment to their practice site from a vendor of their choosing. Coverage is dictated by Fidelis Care Authorization Grids, Prior Authorization Lookup Tool and/or Evolent Specialty Services (formerly NCH) Authorization Grids (Oncology Regimen Specific). Medical Benefit Authorization Grids are plan specific. If a medication is listed

March 30 is National Doctors Day. On this annual observance, Fidelis Care extends sincere gratitude to the doctors and healthcare professionals across New York State who work tirelessly to support the health and wellness of the members and local communities we serve. Your service and dedication to achieving enhanced patient outcomes through quality care is a vital pillar of Fidelis Care’s mission of transforming the health of the community. First commemorated in 1933 by Eudora Brown Almond to honor the contributions of local physicians in Barrow County, Georgia, March 30 was selected because that was the day in 1842 that Dr. Crawford

Beginning March 2, 2024, current enrollees in Qualified Health Plans (Ambetter from Fidelis Care) who are within 200-250% FPL were notified via letter from NY State of Health about the expansion of Essential Plan (EP) coverage in New York State. Members that now qualify for Essential Plan coverage will automatically be moved from their Qualified Health Plan to Essential Plan 200-250, effective April 1, 2024. In addition to the Essential Plan Expansion, effective April 1, 2024, NYS will be implementing the EP Pregnancy Choice Provision.  Individuals who are currently in EP and who report being pregnant will remain EP eligible, instead