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Effective January 1, 2026, providers are required to submit an authorization request for Group and Family Therapy services that exceed 30 visits in a calendar year. The concurrent review requirements will include Mental Health Group and Family Therapy, but excludes Substance Use Disorder (SUD) treatment when the provider/service(s) is/are Article 32 licensed, certified, or otherwise authorized.   The following Mental Health services will require concurrent authorization once the initial 30 visits have been completed: Family Psychotherapy - CPT Code 90847 Fidelis Care will have notification & concurrent review requirements for Family Psychoeducation for any requests after the initial 30 visits per calendar

Fidelis Care will host four Provider Office Hours in February 2026. 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 – February 2026 Topic: Fidelis Care Tools & Resources Overview When:  Thursday, February 12th – 12PM – 1PM EST Click here to register*   Topic: Fidelis Care and Wellcare Quality Programs When:  Wednesday, February 18th – 10AM – 11AM EST Click here to register*

Fidelis Care is pleased to announce that providers now have access the Availity Clinical Quality Validation (CQV) tool designed to help providers close care gaps quickly and accurately. Through the Availity Essentials portal, CQV streamlines documentation and improves quality scores while reducing administrative burden.   What is CQV? Clinical Quality Validation (CQV) is an Availity Essentials application that helps providers: ·         Monitor targeted care gaps/measures for the measurement year. ·         View and respond to payer requests for clinical/medical data. ·         Improve quality scores and reduce administrative burden.   Benefits ·         Streamlined workflow for care gap closure. ·         Faster access to clinical data. ·         Enhanced provider experience across multiple markets.   Availity-led Training for

Recent changes for the 2026 Health Insurance Marketplace may affect eligibility for members at health plans across the nation.  One important update is the way in which current and future Marketplace beneficiaries will apply for Advanced Premium Tax Credits (APTCs) in 2026 and beyond. That’s why Ambetter from Fidelis Care is sharing a quick reminder with our participating providers on the best way to confirm Member eligibility in the Availity Essentials platform and other secure portals.   Grace Periods for Members receiving an APTC Members enrolled in a Marketplace health plan are responsible for completing their premium payments each month. Members that do not

Annual cultural competency training for participating providers is required by the New York State Department of Health.  At this time, The New York State DOH will only accept the approved training offered by the United States Department of Health and Human Services (HHS), Office of Minority Health education program, Think Cultural Health, to fulfill the requirement for provider annual cultural competency training.*   Once the cultural competency training has been completed, providers need to verify completion of the program by emailing the Cultural Competency Attestation Form to: CulturalCompetencyTrainingAttestation@fideliscare.org.   The required Cultural Competency Training needs to be completed annually by December 31st. Providers that completed

We want to inform you that we are currently experiencing high call volumes in our Provider Contact Center, which are impacting wait times. We understand the importance of timely support and appreciate your patience during this period.  Please consider using the Fidelis Care Provider Portal or Availity which offer convenient self-service options including but not limited to: claim status, authorization status and member eligibility. We will provide updates when available. Thank you for your understanding and continued partnership. If you have any questions, please contact your Fidelis Care Provider Engagement Account Manager. To find your designated representative, please click here.  Fidelis Care is proud to be