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Fidelis Care would like to remind providers of a postpartum visit incentive being offered through the New York State (NYS) Medicaid program and inform providers of extended claim submission dates. This program will provide an additional payment to the current NYS Medicaid reimbursement for comprehensive, timely postpartum visits provided to Medicaid Managed Care (MMC)/Fidelis Care Medicaid members. Providers who delivered a person-centered comprehensive postpartum visit as outlined by the American College of Obstetricians and Gynecologists clinical guidelines, including a postpartum depression screen, to Fidelis Care members within 12 weeks of the date of delivery will receive an additional payment of $208.55. 

Fidelis Care is initiating a transition process for providers to identify members who are currently receiving group and family therapy services, and who will continue treatment beyond November 1, 2025, along with current frequency and duration. The below FAQ was created to address provider questions related to the updated authorization requirements, which are in effect for dates of service of November 1, 2025, and thereafter. Providers should submit their member rosters to qhcmbh@fideliscare.org using format outlined below, no later than October 31, 2025. This information will ensure a smooth transition for members engaged in treatment.   As a reminder: Effective November 1, 2025, the

Fidelis Care is partnering with Healthmap Solutions (Healthmap) to provide care coordination services within our kidney health management (KHM) program. As a leading national kidney health management company, the partnership with Healthmap will provide more comprehensive care for Medicaid, HARP, CHP, and Wellcare By Fidelis Care Medicare and Dual Advantage members, with chronic kidney disease (CKD) stages 3, 4, 5, and end stage renal disease (ESRD). If you have a patient with kidney disease, or chronic conditions that may lead to kidney disease, Healthmap may contact you to facilitate care. Healthmap provides collaborative recommendations through workflow-friendly clinical decision support. Healthmap’s KHM program

Effective November 1, 2025, Fidelis Care will begin outreaching for additional clinical information if a member remains hospitalized beyond seven (7) days. This outreach will initiate a concurrent review to assess medical necessity and support discharge planning activities. Please note the following important updates: Initial approvals for emergent admissions and some elective admissions will no longer reflect a 30-day authorization period. Instead, ongoing hospitalization beyond 7 days will require submission of updated clinical documentation to support continued stay. Fidelis Care already conducts outreach for additional clinical information in cases where a member remains hospitalized for greater than 30 days. This new

The following sections of the Fidelis Care authorization grids have been updated effective November 1, 2025.   The following codes have been updated on the Medicaid, Medicare, Essential Plan, and Metal-Level Products Authorization Grids: III.       Outpatient surgery: The following services require prior authorization:                        D.  Skin surgery and other dermatological procedures: Only the following codes require authorization for any place of service: A2030, A2031, A2032, A2033, A2034, A2035, A2036, A2037, A2038, A2039, 11200, 11201, 11719, 15769-15829, 17340-17999, Q4354, Q4355, Q4356, Q4357, Q4358, Q4359, Q4360, Q4361, Q4362, Q4363, Q4364, Q4365, Q4366, Q4367, Q4383, Q4384, Q4385, Q4386, Q4387, Q4388, Q4389, Q4390, Q4391, Q4392, Q4393, Q4394,

Effective October 1, 2025, Ambetter from Fidelis Care will implement a Site of Care Optimization Program to promote cost-effective, high-quality care for members receiving infusion therapies.   Under this initiative, providers will be asked to transition eligible members from outpatient hospital infusion settings to clinically appropriate home infusion or ambulatory infusion suite (AIS) options. Outreach to participating providers will begin in October via fax or phone to gather preferred site-of-care selections.   National Infusion Providers: AcariaHealth, Accredo, KabaFusion, Option Care Local Infusion Providers: Prime Infusions, OptumCare, CNY Infusion, Soleo Health The above are a few examples of contracted providers. Visit fideliscare.org/Find-A-Doctor#/search for a complete list of