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Fidelis Care would like to remind providers of the appropriate coding modifiers to use when billing for a surgical or diagnostic procedure that was discontinued or stopped prior to completion for both facilities and physicians.    Modifiers 73/74 are specifically used by facilities, to indicate that a procedure was discontinued or stopped prior to completion.  Coinciding with these facility modifiers, physicians should bill modifiers 52/53, which also indicates that a procedure was discontinued or cancelled.  If a procedure has been discontinued, both facility and physician claim submissions should reflect the discontinuation, by using the appropriate modifier codes below.   Facility Modifier Codes: Modifier 73:

The following section of the Fidelis Care authorization grids have been updated effective August 1, 2025.   The following code has been added on the Medicare, Medicaid, Essential Plan, and Metal-Level Products Authorization Grids and require prior authorization: III.       Outpatient surgery: P. CAR-T Therapy: Q2058   Visit:  Authorization Grids

Fidelis Care will host three Provider Office Hours in July 2025. During the webinar, Fidelis Care staff will be available to share information, provide an overview of provider resources, and answer your questions. Provider Office Hours – July 2025   Topic: Fidelis Care – Back to Basics When:  Thursday, July 10th – 9AM – 10AM EST Click here to register*   Topic: Claims and COB Overview When:  Thursday, July 24th – 2PM – 3PM EST Click here to

Fidelis Care would like to remind our providers of plan changes for Ambetter From Fidelis Care and Essential Plans in response to a recent NY Senate Bill addressing copayments for PrEP and PEP medications.  The in-network cost share for members will be waived for medications used for PrEP and PEP, provided that an appropriate ICD-10 diagnosis code is documented on the prescription sent to the Pharmacy. Below are updated lists of medications indicated for PrEP and/or PEP. PrEP Medications: Descovy Tab 200-25 MG Apretude INJ 600 MG/3 ML Tuvada 200-300MG; Emtricitabine-tenofovir 200-300MG PEP Medications: Tivicay Tab 50 MG Isentress Tab 400 MG Darunavir

Fidelis Care would like to remind providers that Urgent and Concurrent Authorization Requests cannot be submitted through the Provider Portal, as this will cause delays in processing.   To expedite the processing of Urgent, providers should submit requests through: Availity Essentials, or Fax Urgent requests directly to: (800) 860-8720, and label the request as “Urgent”   Urgent Concurrent Authorization Requests and Concurrent Authorization Requests should be submitted by: Faxing requests directly to: (800) 860-8720, and labeling the request as “Concurrent”   To register for an Availity Essentials account, visit Register and Get Started with Availity Essentials.   For additional questions, or if we can be of assistance in any

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.