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Join us for a focused overview of the CoC+ program and how it supports coordinated, patient-centered care. What we will cover: CoC+ program overview and key components Quality, high utilization, risk and actionable insights How to use Centene Clinical Action (CCA) /CoC+ (Agenda submissions) Ways to support documentation and continuity of care Who Should Attend: This session is intended for provider office staff involved in patient care coordination and performance improvement, including: Providers / Clinicians Care coordinators and care management staff Billing and coding specialists Office managers or administrators  Teams using CCA/CoC+ We appreciate your partnership and look forward to helping you get the

Fidelis Care would like to advise Providers of an update to the Private Duty Nursing (PDN) manual as of July 1, 2026.   Member Demographic Information Form Detailed in section 6.11 of the Private Duty Nursing (PDN) manual, this form is to be completed by the Billing Provider. If support is needed for completion, members’ Care Manager should be contacted. The form includes a home safety attestation and applicable member information regarding school and day program. This form must be submitted with new PDN cases and with 12-month documentation renewal requests, along with the required documentation detailed in Section 6.1 of the PDN

As a reminder, 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 Providers: A live webinar, Centene

Effective July 1, 2026, the following procedures will be removed from prior authorization.   The following RADIOLOGY AND DIAGNOSTIC CARDIOLOGY (RBM) codes have been removed from the Evolent’s Utilization Review Matrix and no longer require prior authorization for Medicaid. Modality Impacted CPT CT ORBIT/EAR/FOSSA WITH O DYE 70480,70481,70482 CT MAXLOFCE AREA; W/O CONTRAST MATL

The following section of the Fidelis Care authorization grids has been updated effective July 1, 2026.             The following codes have been updated on the Medicaid, CHP, Essential Plan, Ambetter Metal-Level Plans, and Medicare Authorization Grids and require prior authorization: C9310 leucovorin calcium (avyxa), inj J1289 narsoplimab-wuug, inj (Yartemlea) J1577 immune globulin, inj (Qivigy) J2361 depemokimab-ulaa, inj (Exdensur) J2789 riboflavin 5'-phosphate, ophthalmic (Epioxahd/Epioxa) J3386 etuvetidigene autotemcel, inj (Waskyra) J3405 onasemnogene abeparvovec-brve, inj (Itvisma) J9053 belantamab mafodotin-blmf, inj (Blenrep) J9062 amivantamab and hyaluronidase-lpuj, inj (Rybrevant) J9232 docetaxel (hospira), inj Q5164 ustekinumab-hmny, inj (Starjemza) Q5165 denosumab-mobz, inj (Oziltus) Q5166 denosumab-desu, inj (Osvyrti/Jubereq) Q5167 denosumab-qbde, inj (Enoby/Xtrenbo) Q5168 ranibizumab-leyk, inj (Nufymco) Q5169 pegfilgrastim-unne, inj (Amlupeg) Q5170 aflibercept-boav, inj (Eydenzelt) Q5171 denosumab-mobz, inj (Boncresa)   For