Добро пожаловать, поставщики медицинских услуг штата Нью-Йорк!

The following sections of the Fidelis Care authorization grids have been updated effective February 1, 2025.   The following codes have been added to the Medicaid DME Authorization Grid:   E0316 Safety enclosure frame/canopy for use with hospital bed, any type E1803 Dynamic adjustable elbow extension only device, includes soft interface material E1804

Fidelis Care would like to inform our providers of plan changes that will be effective January 1, 2025.    Wellcare By Fidelis Care Wellcare Fidelis Dual Plus (HMO D-SNP) - Plan 008 Effective January 1, 2025, Fidelis Care members currently in this plan will be enrolled in Wellcare Fidelis Dual Plus (HMO D-SNP) – Plan 003, unless the member chooses another plan.  

Fidelis Care will host three Provider Office Hours in January 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 – January 2025 Topic: Fidelis Care – Back to Basics When:  Thursday, January 9th – 9AM – 10AM EST Click here to register*   Topic: Claims and COB Overview When:  Thursday, January 23rd – 2PM – 3PM EST Click here to register*

Providers are required to maintain up-to-date demographic information to ensure efficient and timely processing of claims, accurate provider directory information, and appropriate contact information for communication.  As a reminder to our Fidelis Care providers, please review your demographic information in the Provider Portal on a regular basis to ensure the provider data is accurate.  If you have any questions regarding the Provider Portal, or would like to submit your demographic changes in another format (fax, email, or delegated roster), please contact your Fidelis Care Provider Relations Specialist.  To find your designated representative, please visit Contact Your Designated Provider Relations Specialist.  

Fidelis Care is pleased to inform you that the most recent 2024 QARR/HEDIS Care Gap Report has been posted on Provider Access Online (provider portal). This information is indicative of all encounter data on file with Fidelis Care as of 10/22/2024.  This report provides you with the opportunity to review preventative services for which Fidelis does not show your members as receiving in the measurement period.  We strongly suggest that you review the report for opportunities to either render the service, schedule the service to be done before 12/31/24 or if previously performed, submit supplemental data by 2/1/25.  Please notify

The following sections of the Fidelis Care authorization grids have been updated effective January 1, 2025.   The following codes have been updated on the Medicare, Medicaid, Essential Plan, and Metal-Level Products Authorization Grids and require prior authorization: III.       Outpatient surgery: The following services require prior authorization:                   D.  Skin surgery and other dermatological procedures: 15011, 15012               H.  Eyelid & ocular surgery: 66683                                                                                                                                   P. CAR-T Therapy: 38225, 38226, 38227, 38228                                                                                                                                 Q. Urology: 51721, 53865, 53866, 55881, 55882                                                                                                                                  R. Other: 60660, 60661                                                                                                                   V.        Outpatient and DME Services: The following services require prior authorization:               A.    Diagnostic testing