¡Bienvenidos, proveedores!

As you know, Fidelis Care relies upon the receipt of membership information from the New York State Department of Health (SDOH) prior to issuing capitation payments. The date for receiving this information from the SDOH varies from month to month. In certain months, the availability of data may be delayed as much as one week. Nevertheless, Fidelis Care has historically made capitation payments as close to the first of each calendar month as possible.    Presented below is Fidelis Care’s 2026 capitation check and Electronic Funds Transfer (EFT) schedule. Please refer to this to determine the timing of your monthly payment.  Over

Fidelis Care will host three Provider Office Hours in January 2026. During the webinar, Fidelis Care staff will be available to share information, provide an overview of provider resources, and answer your questions. Provider Office Hours – January 2026 Topic: Fidelis Care – Back to Basics When:  Thursday, January 8th – 9AM – 10AM EST Click here to register*   Topic: Fidelis Care and Wellcare Quality Programs When:  Wednesday, January 21st – 10AM – 11AM EST Click here to register*

The following sections of the Fidelis Care authorization grids have been updated effective February 1, 2026.             The following codes have been added to the Medicaid DME Authorization Grid and require prior authorization: E0766  Electrical stimulation device used for cancer treatment, includes all accessories, any type E2606  Positioning wheelchair seat cushion, width 22 inches or wider   Visit:  Authorization Grids

Fidelis Care is pleased to announce that a new Provider Bulletin is now available. The bulletin features updates on important initiatives and the latest news of interest to our provider community. Articles in this issue: ·         Help Prevent the Flu: Encourage Vaccination ·         COVID-19 Reminder ·         Cardiovascular Disease and Statin Therapy ·         Antibiotic Stewardship Starts with Awareness ·         CDC Recommendations for STI Treatment Please download Fidelis Care Provider Bulletin – Volume 11, Issue 4.   To view our Provider Bulletin Library, please visit: Provider Bulletins.

The following sections of the Fidelis Care authorization grids have been updated effective January 1, 2026.             The following codes have been updated on the Medicaid, CHP, Essential Plan, AmBetter Metal-Level Plans, and Medicare Authorization Grids and require prior authorization: C9307 linvoseltamab-gcpt inj C9308 carboplatin (Avyxa) inj J0013  esketamine, nasal spray J1073  testosterone pellet, implant J3387  elivaldogene autotemcel (Skysona) J3389  prademagene zamikeracel (Zevaskyn) J7528  mycophenolate mofetil, suspension J9184  gemcitabine (Avyxa) inj J9256  nipocalimab-aahu inj J9282  mitomycin intravesical J9326  telisotuzumab vedotin-tllv inj (Emrelis) Q5160 bevacizumab-nwgd (Jobevne)   For Medicaid, CHP, Essential Plan, AmBetter Metal-Level Plans, and Medicare, the following codes have been added to the list of drugs that require NCH review: C9307 linvoseltamab-gcpt inj C9308 carboplatin (Avyxa) inj J9184 

The Clinical Laboratory Improvement Amendments of 1988 is federal legislation with the objective of ensuring quality laboratory testing. It applies to any facility or individual Provider that performs laboratory services and wants to receive payments under Medicare and Medicaid programs. Fidelis Care will continue to uphold the Federal and State guidelines to ensure laboratory claims submitted by providers meet these requirements: A valid CLIA certificate for the type of tests performed at each location An active CLIA certificate Exceptions are based on both NYS and CMS Regulations          Providers should submit their CLIA number on the claim as follows: Electronic Claim: Loop