¡Bienvenidos, proveedores!

CIUDAD DE LONG ISLAND, NY (10 de Junio de 2025) Fidelis Care, un plan de salud estatal con más de 2.4 millones de miembros en el Estado de Nueva York y una empresa de Centene Corporation, ha abierto el proceso de solicitud de su programa de subvenciones de salud materna de 2025. Las subvenciones, abiertas para proveedores de atención médica y organizaciones comunitarias de Nueva York, tienen el objeto de financiar programas que apoyen estrategias innovadoras en atención posparto y salud mental materna. La solicitud está disponible en fideliscare.org/maternal-grant. La fecha límite para presentar la solicitud es el 8 de Julio de 2025 a las 5 p.m.

Fidelis Care would like to remind providers of the appropriate coding modifiers to use when billing for a surgical or diagnostic procedure that was discontinued or stopped prior to completion for both facilities and physicians.    Modifiers 73/74 are specifically used by facilities, to indicate that a procedure was discontinued or stopped prior to completion.  Coinciding with these facility modifiers, physicians should bill modifiers 52/53, which also indicates that a procedure was discontinued or cancelled.  If a procedure has been discontinued, both facility and physician claim submissions should reflect the discontinuation, by using the appropriate modifier codes below.   Facility Modifier Codes: Modifier 73:

The following section of the Fidelis Care authorization grids have been updated effective August 1, 2025.   The following code has been added on the Medicare, Medicaid, Essential Plan, and Metal-Level Products Authorization Grids and require prior authorization: III.       Outpatient surgery: P. CAR-T Therapy: Q2058   Visit:  Authorization Grids

Fidelis Care will host three Provider Office Hours in July 2025. 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 – July 2025   Topic: Fidelis Care – Back to Basics When:  Thursday, July 10th – 9AM – 10AM EST Click here to register*   Topic: Claims and COB Overview When:  Thursday, July 24th – 2PM – 3PM EST Click here to

Fidelis Care would like to remind our providers of plan changes for Ambetter From Fidelis Care and Essential Plans in response to a recent NY Senate Bill addressing copayments for PrEP and PEP medications.  The in-network cost share for members will be waived for medications used for PrEP and PEP, provided that an appropriate ICD-10 diagnosis code is documented on the prescription sent to the Pharmacy. Below are updated lists of medications indicated for PrEP and/or PEP. PrEP Medications: Descovy Tab 200-25 MG Apretude INJ 600 MG/3 ML Tuvada 200-300MG; Emtricitabine-tenofovir 200-300MG PEP Medications: Tivicay Tab 50 MG Isentress Tab 400 MG Darunavir

Fidelis Care has received notice from the Office of the Medicaid Inspector General (OMIG) of new compliance program requirements for Medicaid participating providers. Effective April 2020, for New York State (NYS) Social Services Law (SSL) §363-d, and effective December 28, 2022, for the corresponding regulations at 18 New York Codes, Rules and Regulations (NYCRR) Subpart 521-1, NYS Medicaid providers shall adopt, implement, and maintain effective compliance programs aimed at detecting fraud, waste, and abuse in the NYS Medicaid program.   Who is Required to Have a Compliance Program? NYS Social Services Law (SOS) § 363-d and Title 18 of the New York Codes, Rules