Блог Fidelis Care

The Centers for Medicare & Medicaid Services (CMS) require health plans to provide annual education and training regarding our Special Needs Plan (SNP) Model of Care to providers who treat our SNP members. This applies to our Dual Eligible Special Needs Plan (D-SNP) members, who are eligible for both Medicare and Medicaid, and our Chronic Condition Special Needs Plan (C-SNP) members. As stated in our provider manual, all providers who treat our SNP members, regardless of network participation status, must complete Model of Care (MOC) training annually by Dec. 31. The training is designed to help you better understand our approach

During National Health Center Week from August 2 to 8, Fidelis Care recognizes the community health centers that help New Yorkers access the care they need to live healthier lives. Across cities, suburbs, and rural areas, these organizations provide quality healthcare, connect people with important resources, and help improve the health of their communities. Community health centers do far more than provide medical care. They break down barriers to health by offering compassionate, affordable services close to home and ensuring patients receive the support they need. At Harmony Healthcare Long Island, that commitment begins with a simple but powerful belief. "We are

Managing authorization follow-ups just got easier with request for additional information (RFAI). You can securely receive and respond to requests from Fidelis Care — right within Availity Essentials.   Key benefits No calls or faxes — manage authorizations online. Keep requests moving — respond quickly with supporting clinical documentation. Track activity in one place — monitor and manage requests from a single dashboard.   View and respond to RFAIs Use the Authorization/Referral Dashboard to review and respond to requests for additional information. On the Dashboard Summary page, look for Pending Action – Contact Payer in the Status/Last Updated column. Open the authorization and review the

The following section of the Fidelis Care authorization grids has been updated effective September 1, 2026.             The following section of the Medicaid, CHP, Essential Plan, Ambetter Metal-Level Plans, and Medicare Authorization Grids and requires prior authorization: III.       Outpatient surgery: The following services require prior authorization:                                 D.  Skin surgery and other dermatological procedures: Q4110, Q4111           The following codes have been added to the Medicaid, CHP, Essential Plan, Ambetter Metal-Level Plans, and Medicare Authorization Grids and require prior authorization: J0528 fosfomycin disodium J2374 apraclonidine hcl J7176 fibrinogen-chmt (Fesilty)   Visit:  Authorization Grids

Effective September 1, 2026, Fidelis Care will implement the Leveling of Care: Emergency Department Evaluation and Management (E/M) Overcoding for Facility Services Policy (CC.PP.80) for applicable lines of business. This policy is designed to help ensure facility Emergency Department E/M coding accurately reflects the level of resources used during a patient visit. Claims will go through a review prior to payment to determine if the billed level of service is supported by the claim evidence and resources.  This approach is consistent with national billing guidance and industry oversight priorities. Both the Centers for Medicare & Medicaid Services (CMS) and the Office of