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Fidelis Care is partnering with Healthmap Solutions (Healthmap) to provide care coordination services within our kidney health management (KHM) program. As a leading national kidney health management company, the partnership with Healthmap will provide more comprehensive care for Medicaid, HARP, CHP, and Wellcare By Fidelis Care Medicare and Dual Advantage members, with chronic kidney disease (CKD) stages 3, 4, 5, and end stage renal disease (ESRD). If you have a patient with kidney disease, or chronic conditions that may lead to kidney disease, Healthmap may contact you to facilitate care. Healthmap provides collaborative recommendations through workflow-friendly clinical decision support. Healthmap’s KHM program

Effective November 1, 2025, Fidelis Care will begin outreaching for additional clinical information if a member remains hospitalized beyond seven (7) days. This outreach will initiate a concurrent review to assess medical necessity and support discharge planning activities. Please note the following important updates: Initial approvals for emergent admissions and some elective admissions will no longer reflect a 30-day authorization period. Instead, ongoing hospitalization beyond 7 days will require submission of updated clinical documentation to support continued stay. Fidelis Care already conducts outreach for additional clinical information in cases where a member remains hospitalized for greater than 30 days. This new

The following sections of the Fidelis Care authorization grids have been updated effective November 1, 2025.   The following codes have been updated on the Medicaid, Medicare, Essential Plan, and Metal-Level Products Authorization Grids: 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: A2030, A2031, A2032, A2033, A2034, A2035, A2036, A2037, A2038, A2039, 11200, 11201, 11719, 15769-15829, 17340-17999, Q4354, Q4355, Q4356, Q4357, Q4358, Q4359, Q4360, Q4361, Q4362, Q4363, Q4364, Q4365, Q4366, Q4367, Q4383, Q4384, Q4385, Q4386, Q4387, Q4388, Q4389, Q4390, Q4391, Q4392, Q4393, Q4394,

Effective October 1, 2025, Ambetter from Fidelis Care will implement a Site of Care Optimization Program to promote cost-effective, high-quality care for members receiving infusion therapies.   Under this initiative, providers will be asked to transition eligible members from outpatient hospital infusion settings to clinically appropriate home infusion or ambulatory infusion suite (AIS) options. Outreach to participating providers will begin in October via fax or phone to gather preferred site-of-care selections.   National Infusion Providers: AcariaHealth, Accredo, KabaFusion, Option Care Local Infusion Providers: Prime Infusions, OptumCare, CNY Infusion, Soleo Health The above are a few examples of contracted providers. Visit fideliscare.org/Find-A-Doctor#/search for a complete list of

Timely follow-up care after a mental health discharge is a vital component of recovery. Clinical guidelines recommend that individuals discharged from an emergency department (ED) or inpatient setting receive a follow-up visit within seven (7) days. This window is crucial for maintaining continuity of care, reducing the risk of readmission, and supporting long-term wellness. To help meet this need, Fidelis Care has partnered with Brave Health, a virtual behavioral health provider offering accessible services such as therapy, psychiatry, and care coordination. Brave Health’s telehealth model allows members to receive care from the comfort of their homes, making it easier to stay