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Fidelis Care would like to remind providers that it is appropriate to bill a problem‑oriented E&M on the same day as a surgical or preventive service when the issue is separate and significant.  In these cases, correct use of modifier 25 and proper documentation are essential to ensure accurate reimbursement and to avoid duplicate payment for services not separately performed.   Key Rules Use modifier 25 to show the E&M service is distinct from the main procedure or preventive exam. Claims are clinically reviewed to confirm the E&M is separate. If validated, payment includes: 100% of the primary service 50%

You asked and we listened!  Fidelis Care is pleased to announce that Authorization Determination letters on Fidelis Care’s Provider Portal, will now indicate if the letter is an Initial Adverse Determination (IAD) or a Final Adverse Determination Letter (FAD).    Current Letter Details: ABC Medical Center - Member Name - Auth# New Letter Details: ABC Medical Center - Member Name - Auth# - IAD or FAD   To Access the Letters: Use the menu on the left of the Provider Access Online home page to navigate to the File Downloads section. On the File Download page, providers can search by File Type and File Created

NY State of Health has notified health plans and members of Essential Plan 200-250 (also known as Essential Plan 5) that plan coverage will end. The last day of coverage is June 30, 2026. Your patients’ coverage remains the same through that date. This change is due to anticipated cutbacks in federal funding, according to NY State of Health. It only affects people whose income is between 200% and 250% of federal poverty level. Your patients in Essential Plan 1–Essential Plan 4 are not impacted. Impacted individuals received a letter on April 1 from NY State of Health outlining the timeline for

With all the increases in technology, it’s easy to forget that healthcare starts with the people who show up every day wanting to make a difference. At Fidelis Care, we are proud to work with caring and conscientious doctors across New York State. Whether they are seeing patients in their office or administering care in a hospital or emergency room, doctors are the lifeblood of our healthcare system.   March 30 is National Doctors Day. On this annual observance, Fidelis Care shares our gratitude to the doctors and healthcare professionals who support the health and wellness of the members and local communities