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The following codes have been removed from the Medicaid and  Essential Plan Authorization Grids and do not require prior authorization: J0739 cabotegravir inj  J0741 cabotegrvir and rilpivirine inj  J0750 emtricitabine tenofovir df, oral for PReP  J0751 emtricitabine tenofovir alafenamide, oral for PReP  J0799 unclassified FDA approved PReP drugs  J1746 ibalizumab-uiyk (Trogarzo)  J1961 lenacapavir (Sunlenca)  Q0521 Pharmacy supplying fee for HIV pre-exposure prophylaxis FDA approved prescription S0104 zidovudine oral  S0140 saquinavir oral    Visit:  Authorization Grids

Fidelis Care would like to inform providers that doula services will be included in the benefit package for Medicaid Managed Care, HIV Special Needs Plan, and Health and Recovery Plan members effective April 1, 2025.  Doula services can include up to eight (8) visits by a doula during and after pregnancy and continuous support during labor and childbirth.  If a member becomes pregnant within 12 months following a prior pregnancy, the eligibility for doula services will start over with the new pregnancy.  Any unused doula services from the prior pregnancy will not carry over.   Perinatal Visits Up to eight (8) perinatal

Fidelis has partnered with Galileo to provide wraparound services for its network of providers. Galileo is a digital medical practice that delivers high quality, multidisciplinary care. In a single app, patients can receive 24/7 care by text, phone, or video. Galileo is focused on wrapping around a population of Medicaid lives with chronic and complex BH needs in the Finger Lakes & Central Regions. Galileo can support identified Fidelis members through: After Hours and Acute Care: Galileo providers are available 24/7, all year round, to care for patients, minimizing ED and Urgent Care utilization. After a patient has been seen by the

As you know, Fidelis Care relies upon the receipt of membership information from the New York State Department of Health (SDOH) prior to issuing capitation payments. The date for receiving this information from the SDOH varies from month to month. In certain months, the availability of data may be delayed as much as one week. Nevertheless, Fidelis Care has historically made capitation payments as close to the first of each calendar month as possible.    Presented below is Fidelis Care’s 2025 capitation check and Electronic Funds Transfer (EFT) schedule. Please refer to this to determine the timing of your monthly payment.  Over

As part of New York’s Medicaid Redesign Team (MRT) initiative, the NY 1115 Waiver introduced the Social Care Networks (SCN) Program, a transformative model focused on integrating social care into healthcare delivery. There is growing recognition that fully achieving health for all requires a focus not only on physical and behavioral health, but also on Health-Related Social Needs (HRSN). The SCN program encourages partnerships across health and social services to address Medicaid members' diverse needs, such as food insecurity, housing instability, and lack of transportation. Many of these HRSN services may become reimbursable to a member under the provision of