¡Bienvenidos, proveedores!

In an effort to positively impact the health and wellness of our members, Fidelis Care recently sent providers a listing of patients who are non-compliant with their asthma medications.  Please be on the lookout for these letters to help us ensure these patients are receiving appropriate care for their conditions.  Helpful Hints for Treating Asthma: Review your patient’s asthma self-management at each visits.  If your patient doesn’t have an Asthma Action Plan, help create one.  If the patient does have a plan, you may need to adjust the plan based on the patient’s behavior.  Check Asthma Medications: If your patient is

Fidelis Care would like to remind providers of the New York State APG Ancillary Policy when submitting APG claims.  Please reference the links below for more detailed information. Informational Web Links: Procedures Subject to the Ancillary Policy Hospitals - see APG Provider Manual (Section 4.4) Freestanding Diagnostic and Treatment Centers Notice If you have any questions, please contact your Fidelis Care Provider Relations Specialist.  To find your designated representative, please visit Contact Your Designated Provider Relations Specialist.

A DRG or Diagnosis Related Group is a mechanism used for payment by payers and certain facilities such as short-term acute care hospitals, long-term acute care hospitals, acute inpatient psychiatric hospitals, and acute inpatient rehabilitation facilities. In a DRG claim type, ICD-10 and ICD-10 PCS codes are submitted by a facility and then grouped into a DRG by computer algorithm. The DRG assigned to the claim is determined by the MS-DRG methodology (created by CMS) if it is a Medicare claim, or by the APR-DRG system (created by 3M company) for non-Medicare claims. As of 2023, New York State is using

Fidelis Care has made changes to our Child Health Plus (CHP) Formulary. Some of the changes relate to quantity limitations, authorization requirements, as well as drugs being removed and added to the formulary.   Part I: Formulary Additions & PA/ST/QL Removals Drug/Product Action Effective Date Rykindo Add with PA 10/01/2023

Fidelis Care would like to notify our providers that service Fidelis Care New Jersey members (previously WellCare of New Jersey) with updated information on where to send authorization requests and other important contact information.  Authorization Requests: For prior authorizations, visit our secure provider portal at provider.fideliscarenj.com. Additional information can also be found in the notice to providers found here. Please Note:  MLTSS members: All outpatient services prior authorization requests can be faxed to 1-855-573-2346. Non MLTSS members: Please log in to submit your Outpatient Authorization Requests & Inpatient Hospitalization Clinical only (not Authorization) submissions. For information regarding the status of a prior authorization