Добро пожаловать, Брокеры!

Fidelis care would like to inform all participating providers that we will be conducting an Access & Availability Survey in the coming weeks. This survey ensures that providers are meeting NYS mandated Access & Availability standards for all Fidelis Care members.

The survey will assess:

• Timeliness of appointment scheduling based on appointment type.  For example:
  • Routine Care
  • Urgent Care
  • Non-Urgent Sick Visit
  • After Hours Availability 
• Accuracy of provider directory information.

This applies to Primary Care Providers, OB/GYNs, Oncologists, and Behavioral Health Providers.

Typical reasons for non-compliance include:

• Appointment scheduling timeframes do not meet state guidelines.
• Office staff misrepresents the provider as:
  • Not accepting new patients
  • Not a plan participant
  • Restricted to specialty care or changed specialty
• Staff requires previous medical records or a questionnaire be completed before appointment can be made.
• Provider requires a referral.
• Provider not at site and no alternative provider available.
• Inaccurate or outdated phone information.
• After-hours access:
  • No answer or no answer at the after-hours number.
  • Voicemail with no instruction on how to access non-emergency after-hours care. (Messages that instruct patients to go directly to the hospital are counted as failures.)
  • A voicemail with instruction to leave message for provider but the call-back time was unspecified.

To assist your office in preparing for the upcoming surveys, we’ve created a tip sheet outlining NYS standards that you can access here.

To review directory information accuracy, providers can use Provider Portal or the Find a Doctor Tool.

REMINDER: To remain in compliance providers must ensure their contact information, appointment availability, and patient access procedures meet state standards.

If you have any questions or would like assistance, please reach out to your Fidelis Care Provider Engagement Account Manager. To locate your design and representative, please visit Contact Your Designated Provider Relations Specialist