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The following section of the Fidelis Care authorization grids have been updated effective July 1, 2025.   The following DME codes have been removed from the Medicaid, Essential Plan, and Ambetter Metal-Level Products Authorization Grids and no longer require prior authorization: K0001  Standard wheelchair L0621  SIO flex pelvisacral prefab L2630  Pelvic control band and belt B L3809 Whfo w/o joints pre ots   The following code has been updated on the Medicaid, Essential Plan, and Ambetter Metal-Level Plans Authorization Grids and requires prior authorization: Q0224   pemivibart (Pemgarda)   The following codes have been updated on the Medicare, Medicaid, Essential Plan, and Ambetter Metal-Level Plans Authorization Grids and require prior authorization: C9174   datopotamab deruxtecan-dlnk

The Centers for Medicare and Medicaid Services (CMS) requires that providers receive Medicare Special Needs Program (SNP) Model of Care (MOC) Training annually.  As part of our ongoing commitment to access, quality of service, and quality of care for our members, Fidelis Care provides this training annually and during the new contract process to all network providers, as well as to providers who regularly see our SNP members.    The training module can be accessed by logging into our provider portal, please visit Provider Access Online.  After logging in, if training and attestation is required, you will receive a notification on the Home Page. 

Fidelis Care will host three Provider Office Hours in June 2025. During the webinars, Fidelis Care staff will be available to share information, provide an overview of provider resources, and answer your questions. Provider Office Hours – June 2025   Topic: Behavioral Health Overview When:  Thursday, June 12th – 11 AM – 12 PM EST Click here to register*   Topic: Fidelis Care and Wellcare - Quality Programs When:  Wednesday, June 25th – 10 AM – 11 AM EST

The following codes on the Evolent/Fidelis Care authorization grid have been updated effective June 1, 2025. The following codes have been removed from the Evolent Radiology Cardiology Utilization Review Matrix and no longer require prior authorization for Wellcare by Fidelis Care, Medicaid, Essential Plans, and Ambetter Metal-Level Products: Transthoracic Echocardiogram - 93307, 93303, 93304, 93306, 93307, 93308, 93320, 93321, 93325, 93356 Chest CT - 71250, 71260, 71270, 0722T CT for Low Dose Lung Cancer Screening - 71271   Visit:  Authorization Requests

Diabetes is the leading cause of chronic kidney disease affecting almost one in three people. Clinical guidelines recommend that all people with diabetes have routine tests to detect kidney disease. However, less than half get the needed tests.  Kidney disease does not show symptoms until later stages of the disease, and this makes early detection the key to managing the disease appropriately. The Kidney Health Evaluation (KED) assesses both kidney function with an estimated glomerular filtration rate (eGFR) and kidney damage with a urine albumin-creatinine (uACR) to develop an appropriate treatment plan. What do you need to do? Order both an estimated glomerular filtration rate