¡Bienvenidos, proveedores!

Fidelis Care will host three Provider Office Hours in June 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 – June 2025   Topic: Behavioral Health Overview When:  Thursday, June 12th – 11 AM – 12 PM EST Click here to register*   Topic: Fidelis Care and Wellcare - Quality Programs When:  Wednesday, June 25th – 10 AM – 11 AM EST

The following codes on the Evolent/Fidelis Care authorization grid have been updated effective June 1, 2025. The following codes have been removed from the Evolent Radiology Cardiology Utilization Review Matrix and no longer require prior authorization for Wellcare by Fidelis Care, Medicaid, Essential Plans, and Ambetter Metal-Level Products: Transthoracic Echocardiogram - 93307, 93303, 93304, 93306, 93307, 93308, 93320, 93321, 93325, 93356 Chest CT - 71250, 71260, 71270, 0722T CT for Low Dose Lung Cancer Screening - 71271   Visit:  Authorization Requests

Diabetes is the leading cause of chronic kidney disease affecting almost one in three people. Clinical guidelines recommend that all people with diabetes have routine tests to detect kidney disease. However, less than half get the needed tests.  Kidney disease does not show symptoms until later stages of the disease, and this makes early detection the key to managing the disease appropriately. The Kidney Health Evaluation (KED) assesses both kidney function with an estimated glomerular filtration rate (eGFR) and kidney damage with a urine albumin-creatinine (uACR) to develop an appropriate treatment plan. What do you need to do? Order both an estimated glomerular filtration rate

Wellcare and Conversio Health have partnered together to bring providers a comprehensive COPD condition management program to support managing high-risk patients with chronic respiratory conditions—target patient population includes members with a history of ED visits or hospitalizations. Conversio Health services are available to Wellcare by Fidelis Care and Wellcare members. Conversio Health’s expert team of clinical pharmacists, respiratory therapists, and health coaches are focused on giving providers and patients the best quality of service available to help them breathe better.  These services are at no cost to patients and, include: COPD medication therapy optimization Improvement of medication adherence Providing medication affordability,

Earlier this month Fidelis Care notified providers that, pursuant to the regulatory requirements defined in Article 44 of the New York State Public Health Law for all Managed Care Organizations, it was implementing a change to its appeals process by requiring the submission of written member consent.  The change was scheduled to become effective on June 1, 2025.    NYSDOH has informed Fidelis that it is currently reviewing the policy and advised Fidelis Care to postpone its implementation.  Therefore, Fidelis Care is rescinding the implementation of the policy until further notice and will provide an update when more information is available.   For additional

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.