8/9/2023
• Posted by Provider Relations
Providers are required to maintain up-to-date demographic information to ensure efficient and timely processing of claims, accurate provider directory information, and appropriate contact information for communication. As a reminder to our Fidelis Care providers, please review your demographic information in the Provider Portal on a regular basis to ensure the provider data is accurate.
If you have any questions regarding the Provider Portal, or would like to submit your demographic changes in another format (fax, email, or delegated roster), please contact your Fidelis Care Provider Relations Specialist. To find your designated representative, please visit Contact Your Designated Provider Relations Specialist.
8/1/2023
• Posted by Provider Relations
As your health plan partner, Fidelis Care would like to share critical information about changes underway in Medicaid Managed Care, Essential Plan, Child Health Plus, HARP, and MLTC programs across New York State.
New York State and Fidelis Care sent notices in the early spring to its first cohort of Medicaid, Essential Plan, Child Health Plus, HARP, and MLTC enrollees with June 30 coverage end dates, a process that will continue each month until all enrollees have been redetermined. Throughout the renewal process, Fidelis Care continues to offer assistance to members to complete their renewal application and maintain access to free
7/31/2023
• Posted by Provider Relations
Fidelis Care is pleased to inform you that the most recent 2023 QARR Non-Compliance 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 6/20/2023. Please refer to the most recent "Non-Compliance Report" instruction letter to understand the information being provided on each tab of the Excel Spreadsheet. Please notify any staff involved with quality management and advise that these documents have been posted. If you have any questions, please call the Provider Call Center at 1-888-FIDELIS (1-888-343-3547).
7/31/2023
• Posted by Provider Relations
The following sections of the Fidelis Care authorization grids have been updated effective September 1, 2023.
The Medicaid, Medicare, Essential Plan and Metal-Level grids have been updated as follows:
II. Inpatient Admissions: All inpatient admissions require an authorization.
Fidelis Care does not require authorization of emergency room services or any emergent service required to provide stabilization of an emergent condition. Fidelis Care does require authorization of post stabilization services and inpatient admissions after emergency room services are completed. All facility admissions are reviewed for medical necessity. Note: New fax number for Inpatient ER is 833-663-1602 (formerly 347-868-6411).
III. Outpatient surgery: The following services
7/28/2023
• Posted by Provider Relations
Fidelis Care would like to notify our providers of an update to our Applied Behavior Analysis (ABA) Clinical Policy.
Effective October 1, 2023, ABA services are not covered by Fidelis Care when provided in a school setting and the site of service must be identified in connection with a service authorization request.
ABA treatment cannot be requested for services that are otherwise covered under the Individuals with Disabilities Education Act (IDEA) or provided in an educational or school-based setting. If medically necessary, supplemental ABA services can occur in coordination with educational services and plans.
Place of Service Code “03”
Effective October 1, 2023, claims
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