¡Bienvenidos, proveedores!

¡Tu preguntaste y nosotros escuchamos! Fidelis Care se complace en anunciar una nueva funcionalidad en el Portal de proveedores, que permite a los proveedores presentar disputas de reclamos electrónicamente. Con esta nueva herramienta fácil de usar, los proveedores pueden presentar nuevos envíos de COB, apelaciones de reclamos o reconsideraciones de reclamos.

Fidelis Care is pleased to announce that the new Quality Care Incentives (QCI) Program is now available on Provider Access Online. Once logged in, please navigate to the File Downloads section to access the brochure.   Fidelis Care's QCI Program rewards groups/practices for providing recommended preventive care, for caring for members with chronic disease, and for comprehensive obstetrical care. As your health plan partner, we remain committed to rewarding our providers for achieving high-quality outcomes, and have made significant changes to the program for measurement year 2024 to align with our shared goals, encourage participation, and recognize regional differences within New York State.     For

Fidelis Care would like to inform providers of an upcoming change to the Comprehensive Psychiatric Emergency Program (CPEP) rate code 4009 for Crisis Outreach Service Visits.  Effective July 1, 2024 rate code 4009 will be retired for Medicaid plans, including HIV Special Needs Plans (HIV SNPs), and Health and Recovery Plans (HARPs).  With the announced State Plan Amendment (SPA) approval for Crisis Intervention services, CPEPs are allowed to bill utilizing the mobile crisis rate codes for both adults and children.   If you have any questions, please contact your Fidelis Care Provider Relations Specialist. To find your designated representative, please visit Contact Your Designated

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: Pharmacy Benefit Transition to Express Scripts Access the New Prior Authorization Lookup Tool PCP Requirement Underway for Essential Plan Provider Surveys Drive Improvement at Fidelis Care Sexually Transmitted Infections Treatment Guidelines Please download Fidelis Care Provider Bulletin – Volume 10, Issue 1.   To view our Provider Bulletin Library, please visit: Provider Bulletins.

The Medicaid Drug Rebate Program (MDRP), established by the Omnibus Budget Reconciliation Act of 1990 (OBRA '90), requires that drug manufacturers to enter into an agreement with the Centers for Medicare and Medicaid Services (CMS) to provide rebates for drugs covered by Medicaid. Reimbursement for practitioner-administered drugs is only allowed if the drug qualifies for rebate in accordance with 42 USC 1396r-8.   Providers are encouraged to use the tools below to determine if a practitioner-administered drug will be reimbursable through Fidelis Care Medicaid and HARP plans.  Claims submitted with NDC numbers that are not on the list of approved manufacturers will