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Fidelis Care will host three Provider Office Hours in November 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 – November 2025   Topic: Fidelis Care – Back to Basics When:  Thursday, November 13th – 9AM – 10AM EST Click here to register*   Topic: Fidelis Care and Wellcare - Quality Programs When:  Wednesday, November 19th – 10 AM – 11 AM EST

As we approach the final quarter of the year, we’re entering a critical phase of the Continuity of Care (CoC) program. Our shared goal remains clear: to ensure patients receive timely, high-quality care while closing the most impactful clinical gaps by December 31. To support you in this effort, we’ve refined the appointment agenda to focus on the most urgent and actionable opportunities with a particular emphasis on risk adjustment conditions. This streamlined approach is designed to: Prioritize the highest-value clinical care gaps for closure; Maximize your time during each patient encounter to focus on the more critical clinical and

Fidelis Care would like to inform providers that we are unable to accept calls from Artificial Intelligence (AI) entities or other automated systems to verify claim status, obtain remittance information, or respond to any other inquiries.  Fidelis Care representatives may only engage with a live person to verify PHI and ensure HIPAA compliance.   Providers are also encouraged to use the Fidelis Care Provider Portal to obtain needed information. For more information on the Provider Portal, please visit:  https://www.fideliscare.org/Provider/Provider-Access-Online-Resources   For additional questions, or if we can be of assistance in any way, please contact your Fidelis Care Provider Engagement Account Manager. To identify your

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

Access to quality care is important to eliminate health disparities and increase the quality and years of healthy life for all New Yorkers. The NYSDOH requires that certain Access and Availability Standards be met by PCPs, OB/GYNs, specialists, and behavioral health providers where applicable. Click here to view the full list of standards, including situations and timeframes.   For additional questions, or if we can be of assistance in any way, please contact your Fidelis Care Provider Engagement Account Manager. To find your designated representative, please click here. 

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