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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 2025 capitation check and Electronic Funds Transfer (EFT) schedule. Please refer to this to determine the timing of your monthly payment.  Over

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. There is growing recognition that fully achieving health for all requires a focus not only on physical and behavioral health, but also on Health-Related Social Needs (HRSN). 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 HRSN services may become reimbursable to a member under the provision of

Fidelis Care would like to inform providers of a change to our Behavioral Health discharge planning support process effective February 1, 2025. Beginning February 1, the Fidelis Behavioral Health Utilization Manager will be the primary contact for collaboration for your inpatient members and will coordinate care with case managers to assist as needed.  The Behavioral Health UM team can provide the name and extension of the Behavioral Health Transitions Care Manager or the assigned HARP Care Manager (if applicable) for additional support.  Feel free to communicate with the care management team for questions or help with discharge planning at 1-888-343-3547 ext.

Fidelis Care would like to inform providers of an amendment to the The New York State Department of Health 1915(c) Children’s Waiver that requires all Health Homes Serving Children (HHSC), Care Management Agencies (CMAs), Children and Youth Evaluation Services (C-YES), and Children’s Home and Community Based Service (HCBS) Providers to complete Mandated Reporter Training annually, effective January 1, 2025.   HCBS providers, HHSC, CMA, and C-YES staff are mandated to report suspected child abuse or maltreatment, per NYS Social Services Law 413. HCBS providers, HHSCs, Children’s CMAs, and C-YES staff working directly with children are required to receive Mandated Reporter training prior

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 11/14/2024.  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 medical record supplemental data by 2/1/25.

The following sections of the Fidelis Care authorization grids have been updated effective February 1, 2025.   The following codes have been added to the Medicaid DME Authorization Grid:   E0316 Safety enclosure frame/canopy for use with hospital bed, any type E1803 Dynamic adjustable elbow extension only device, includes soft interface material E1804