Member
Providers
Shop For a Plan

Renewal Information

Help Keep Your Patients Covered

Health insurance will no longer be automatically renewed for Medicaid Managed Care, Essential Plan, Child Health Plus, or HealthierLife (HARP) members. These members will now need to take action to stay covered.

Doctor-Checklist-Animation

Smiles-that-Shine

How You Can Help

  • Patients in Medicaid Managed Care, Essential Plan, Child Health Plus, or HARP plans with a coverage end date of June 30, 2023 or later will need to renew their health insurance through the NY State of Health Marketplace, their Local Department of Social Services, or NYC’s Human Resources Administration.
  • Check your patient’s renewal (recert) date by going to Fidelis Care’s Provider Portal and accessing the patient details. If the renewal date is within the next 90 days, please remind your patient that they will need to renew their coverage. You can share the renewal information, located below, with your patient. Refer to the Q&A below for more details.

Smiles-that-Shine

Renewal Information for Your Patients

 

 Doctor-Checklist-Animation

 

Doctor-Checklist-Animation

 

Doctor-Checklist-Animation

 

NYS-Image-Blue

 

Call Fidelis Care at 1-866-435-9521; TTY: 711.

➥ Monday-Friday from 8:30 AM-6 PM.

 

Fill out our contact form at fideliscare.org/renew-help

➥ A Representative will call you to help with renewing your coverage.

 

Visit a Fidelis Care Community Office or StreetSide RV for in-person help. 

➥ View locations at fideliscare.org/offices.


If a member enrolled in their health insurance through NY State of Health, they can also renew directly online. Members also can call NY State of Health at 1-855-355-5777; TTY: 1-800-662-1220, from Monday-Friday from 8 AM-8 PM or Saturday from 9 AM-1 PM.


We're Here to Help

Order printed resources and translations, or request to have a representative at your office to help with renewals.

Smiles-that-Shine

 

Renewal/Redetermination Process Q/A

How can I help my patients understand when they need to renew their coverage?
  • Review your eligibility verification procedures to make sure they include coverage end date information. Fidelis Care transmits coverage end dates in our real time electronic data interchange (EDI) 270/271 transactions (Instructions to access this information are available here: EDI Tip Sheet).  Most Fidelis Care members need to act starting 45 days from their coverage end date, with the deadline typically 15 days before coverage ends.
  • Primary Care Providers - Routinely download your provider roster from the Fidelis Care Provider Portal . This roster contains the ‘recert date’ for your Fidelis Care patients. Share this date with your patients and let them know to contact us to stay insured.
  • Distribute education materials from New York State and Fidelis Care about the renewal requirements and encourage members to get in touch with us for help.
What does the ‘Recert Date’ field on my Provider Portal roster mean?

The ‘recert date’ field published on the provider rosters of active members is the first date that members can take action to complete their renewal application on the NY State of Health Marketplace. 

It is typically 45 days before their coverage end date. The deadline for members to take action to maintain coverage without a lapse is 15 days prior to their coverage end date. It can also be helpful for you and your patients to understand when their coverage end date is if no action is taken.

For example, a member has coverage active through June 30, 2023 with eligibility through the NY State of Health Marketplace. The first date of action, also known as the recertification date, is May 16, 2023. The deadline for the member to take action without a risk of coverage lapsing is June 15, 2023. 

Members with recertification dates other than the 16th of the month prior to their coverage ending have eligibility managed through their Local Department of Social Services or Human Resources Administration in NYC. Their recertification date is the deadline given on their renewal paperwork.

What is the process to recertify and what are the different methods?

  1. Redetermination/renewal is the annual process, required by New York State, for most Medicaid, HARP, MLTC, EP, and CHP members to maintain health insurance coverage. It has been paused since March 2020 due to the COVID-19 public health emergency (PHE).
  2. New York State requires documentation around areas like income and household size to determine eligibility each year – either through an electronic process for those with eligibility on the NY State of Health website or through a paper process for those with eligibility through their county LDSS or HRA in NYC.
  3. New York State will notify members based on their contact preference. For paperless renewals, members will receive an email alert when NY State of Health posts new notices to their online account. For printed renewals, notices will be mailed via US Postal Service from the HRA in NYC or local DSS.
  4. If members need to provide information, the notification will provide instructions on next steps.
  5. If members do not need to provide information, the notification will alert them that their renewal is complete.
  6. Fidelis Care will also provide communications via email and phone outreach. Members should also log in to their Fidelis Care Member Portal account for information and guidance on next steps.
  7. When connecting with us over the phone or in person at community offices or events, Fidelis Care can also look up the member’s recertification (renewal) date, and tell them when they will need to take action.
  8. Based on the member’s renewal date, they can expect to receive communications about taking action to renew about 60 days before this date.
  9. Fidelis Care can provide assistance at any point in the renewal process and answer any questions they may have. 
How can we partner with Fidelis Care to make it easier for members to recertify?
  • Fidelis Care has developed educational materials (including print and digital) in multiple languages to help members understand the changes coming in the renewal process, and providers can help by making these materials available in their offices and during patient encounters.
  • Providers can work with Fidelis Care to understand when their patients need to take action to keep their coverage and help communicate reminders and alerts to do so.
  • Fidelis Care’s team of facilitated enrollers are available to come onsite to provider offices and locations at agreed upon timeframes to assist members in keeping their coverage and navigating through the renewal process. 
What guidance is available to develop provider communications to patients about these changes?
The New York State of Health has developed a comprehensive communications toolkit available for providers and contains templates of a wide range of communications specific to needing to renew coverage, available here: https://info.nystateofhealth.ny.gov/PHE-tool-kit
What should providers use the portal for and when should they contact the call center?
Providers should use the IVR/Provider Portal for eligibility dates and initial claim status. Specific questions on a Fidelis Care member’s enrollment can be addressed with a representative.
Are there guidelines for retro activations?
Retroactivity of enrollment will vary case by case and is determined by a range of factors including LDSS and NYSOH policies that are upstream of Fidelis Care’s enrollment processes. Providers are encouraged to routinely run eligibility verification processes to validate patient coverage in both managed care and fee-for-service environments.