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The following sections of the Fidelis Care authorization grids have been updated.           The following section of the Medicaid, CHP, Essential Plan, Ambetter Metal-Level Plans, and Medicare Authorization Grids and requires prior authorization effective October 1, 2026: III.      Outpatient surgery: The following services require prior authorization:                    D.  Skin surgery and other dermatological procedures:          Only the following codes require authorization for any place of service: A2046, A2047, A2048, A2049, A2050, Q4207, Q4223, Q4243                              V.       Outpatient and DME Services: The following services require prior authorization:                    A.    Diagnostic testing:                          Proprietary Laboratory Analysis: 0666U, 0668U, 0669U, 0689U, 0692U, 0694U, 0698U         The following codes have been updated on the

To facilitate the timely processing of provider demographic and termination requests, and to ensure appropriate member notification, Fidelis Care would like to remind providers of the required submission timeframes and methods. Providers are encouraged to review these requirements carefully and submit all requests in accordance with the outlined procedures.   Timely Submission Requirements Provider Demographic/Office Changes: Submit at least 30 days prior to the effective date. Provider Terminations: Submit at least 60 days prior to the effective date. Please note: The effective date of the requested change will be no earlier than the date Fidelis Care is notified.   Submission Methods Online: Directory changes can

To ensure that claims for EVV-applicable services are supported by a valid Electronic Visit Verification (EVV) record prior to payment, this guidance outlines billing requirements, verification processes, denial criteria, and provider responsibilities. These requirements support program integrity, regulatory compliance, and accurate reimbursement for authorized services. This billing guidance applies to all providers rendering services subject to Electronic Visit Verification requirements, including but not limited to: Personal Care Services (PCS) Consumer Directed Personal Assistance Services (CDPAS) Other services designated by federal or state EVV requirements Fidelis Care requires that all EVV-applicable services be supported by a valid EVV transaction documenting service delivery. Claims for

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

Access to quality care is essential to reducing health disparities and improving the quality and length of life for all New Yorkers.   The New York State Department of Health (NYSDOH) and CMS require that specific Access and Availability Standards be met by Primary Care Providers (PCPs), OB/GYNs, Specialists, and Behavioral Health Providers.   To ensure compliance, Fidelis Care conducts regular Access & Availability surveys to confirm providers meet these state-mandated standards for all Fidelis Care members.   The survey evaluates: Timeliness of appointment scheduling by appointment type Accuracy of provider directory listings Responsiveness of phone systems and office staff   Common issues leading to non-compliance include: Appointment