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Fidelis Care is pleased to announce that a new Provider Bulletin is now available. The bulletin features updates on important initiatives and the latest news of interest to our provider community. Articles in this issue: ·         Championing Mental Health: Early Intervention is Key ·         Important Reminders About HIV Prevention and Testing ·         Supporting Maternal Health for Healthy Pregnancies and Babies ·         Encourage Preventive Cancer Screenings ·         Help Your Patients of All Ages Stay Active! ·         Access and Availability Standards   Please download Fidelis Care Provider Bulletin – Volume 11, Issue 3.   To view our Provider Bulletin Library, please visit: Provider Bulletins.

As part of an ongoing series, Fidelis Care will highlight some best practices we learn from our partners across the State in the interest of providing the best experience possible for our members. For this month’s highlight, we’re looking at the Teach-Back Method, a communication technique where providers ask patients to repeat back key information in their own words. This helps confirm understanding, identify confusion, and reinforce learning—especially around diagnoses, medications, and follow-up care.   How It Works After explaining a concept or instruction, you may want to say: “I want to make sure I explained this clearly. Can you tell me how you’ll manage

The following sections of the Fidelis Care authorization grids have been updated effective October 1, 2025.             The following code has been added to the Medicaid DME Authorization grid and requires prior authorization for Medicaid, Medicare, Essential Plan, and Metal-Level lines of business: L1907   Afo supramalleolar custom   The following code has been added on the Medicaid, Medicare, Essential Plan, and Metal-Level Products Authorization Grids and requires prior authorization: J9306 pertuzumab (Perjeta)   The following code has been added on the Medicaid, Essential Plan, and Metal-Level Products Authorization Grids and requires prior authorization: J9308 ramucirumab (Cyramza)   The following code has been added on the Medicaid and Metal-Level Products Authorization

Fidelis Care will host two Provider Office Hours in September 2025. During the webinars, Fidelis Care staff will be available to share information, provide an overview of provider resources, and answer your questions. Provider Office Hours – September 2025 Topic: Quality Office Hours- Clinical Documentation Improvement When:  Wednesday, September 17th – 10AM – 11AM EST Click here to register*   Topic: Fidelis Care – Back to Basics When:  Thursday, September 18th – 9AM – 10AM EST Click here to register*

To ensure timely processing and avoid delays, providers should limit all prior authorization fax transmissions to 75 pages or less. Faxes exceeding 75 pages may be delayed or fail to process, which could impact our ability to efficiently and comprehensively process the request.   Tips for Successful Fax Transmission: Assure the fax is 75 pages or less in total, including cover page. Only include information related to the specific request.   Break large documents into multiple faxes (each under 75 pages). Label each part clearly (e.g., “1 of 3,” “2 of 3,” etc.).   Fax Numbers for Utilization Management Authorization Requests: Physical Health - (800)

Fidelis Care has received notice from the Office of the Medicaid Inspector General (OMIG) of new compliance program requirements for Medicaid participating providers. Effective April 2020, for New York State (NYS) Social Services Law (SSL) §363-d, and effective December 28, 2022, for the corresponding regulations at 18 New York Codes, Rules and Regulations (NYCRR) Subpart 521-1, NYS Medicaid providers shall adopt, implement, and maintain effective compliance programs aimed at detecting fraud, waste, and abuse in the NYS Medicaid program.   Who is Required to Have a Compliance Program? NYS Social Services Law (SOS) § 363-d and Title 18 of the New York Codes, Rules