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Fidelis Care would like to remind our providers of plan changes effective January 1, 2025, for Ambetter From Fidelis Care and Essential Plans. In order for members to obtain the in-network cost share benefit for Diabetes and Maternity Services, providers should follow the below guidance when sending prescriptions to pharmacies for applicable members.   As a reminder, members who become pregnant are required to report their pregnancy to the New York State of Health Marketplace Phone Number below to be eligible for the Pregnancy Cost-Share Waiver. New York State of Health Marketplace Phone: (855) 355-5777 TTY: (800) 662-1220.  

Grants of $10,000 to $20,000 aim to improve behavioral health outcomes, especially in underserved communities Deadline to apply is 5 p.m. EDT March 28, 2025 LONG ISLAND CITY, NY (March 5, 2025) Fidelis Care, a statewide health plan with more than 2.4 million members in New York State and a Centene Corporation company, has opened the application process for its 2025 behavioral health grant program. The grants – ranging from $10,000 to $20,000 – are intended to enhance the integration of behavioral health and primary care through innovative strategies. These efforts aim to bridge care gaps for vulnerable populations by promoting comprehensive support. The application is

Fidelis Care will host three Provider Office Hours in March 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 – March 2025   Topic: Fidelis Care – Back to Basics When:  Thursday, March 13th – 9AM – 10AM EST Click here to register*   Topic: Fidelis Care and Wellcare Quality Programs When:  Wednesday, March 26th – 10:00AM – 11:00AM EST Click

The following section of the Fidelis Care authorization grids have been updated effective April 1, 2025.   The following codes have been added to the Medicare Authorization Grid and do not require prior authorization: B. Durable Medical Equipment: The following DME codes do not require an authorization: L3660, L3915   Visit:  Authorization Grids

Fidelis Care would like to remind providers of CMS correct coding guidelines to prevent billing errors and potential audits.  Fidelis Care has found instances where claims for the same service were billed multiple times using the same revenue code.  Per CMS guidelines, providers must ensure that each service charge has a distinct revenue code.   Reference Material Centers for Medicare & Medicaid Services (Chapter 1/ Subsection 120.3 - Suspect Duplicates, Page 261 and 263) - Click Here   If you have any questions, please contact your Fidelis Care Provider Engagement Account Manager. To find your designated representative, please visit Contact Your Designated Provider Relations Specialist.