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Fidelis Care would like to remind our providers of plan changes for Ambetter From Fidelis Care and Essential Plans in response to a recent NY Senate Bill addressing copayments for PrEP and PEP medications.  The in-network cost share for members will be waived for medications used for PrEP and PEP, provided that an appropriate ICD-10 diagnosis code is documented on the prescription sent to the Pharmacy. Below are updated lists of medications indicated for PrEP and/or PEP. PrEP Medications: Descovy Tab 200-25 MG Apretude INJ 600 MG/3 ML Tuvada 200-300MG; Emtricitabine-tenofovir 200-300MG PEP Medications: Tivicay Tab 50 MG Isentress Tab 400 MG Darunavir

Fidelis Care would like to remind providers that Urgent and Concurrent Authorization Requests cannot be submitted through the Provider Portal, as this will cause delays in processing.   To expedite the processing of Urgent, providers should submit requests through: Availity Essentials, or Fax Urgent requests directly to: (800) 860-8720, and label the request as “Urgent”   Urgent Concurrent Authorization Requests and Concurrent Authorization Requests should be submitted by: Faxing requests directly to: (800) 860-8720, and labeling the request as “Concurrent”   To register for an Availity Essentials account, visit Register and Get Started with Availity Essentials.   For additional questions, or if we can be of assistance in any

Fidelis Care received notice from New York State Office of Addiction Services and Support (OASAS), that providers are required to bill OTP bundle services under the APG methodology effective November 3, 2025. This applies to Medicaid Managed Care (MMC) plans, including Mainstream MMC plans, HIV Special Needs Plans (HIV SNPs), and Health and Recovery Plans (HARPs). Initiative Timeline: Beginning July 1, 2024, providers were given the option to bill OTP bundle services either under the existing OTP bundle rate codes or the APG methodology.  The May memorandum also indicated that OASAS would zero out the bundle rate codes (7969-7976) after a

You asked and we listened!  Fidelis Care is pleased to announce that Health Savings Unit (HSU) Recovery letters are now available on Provider Access Online, Fidelis Care’s Provider Portal, in the File Download section.  To access the HSU letters: Use the menu on the left of the Provider Access Online home page to navigate to the File Downloads section. On the File Download page, providers can search by File Type and File Created date range. Click on the letter you would like to download.  HSU letters will include only the provider’s name and provider identification number. To dispute an HSU retraction, providers

Fidelis Care’s Pharmacy Services would like to provide clarification on how medications are covered under member’s medical and pharmacy benefits.   Medications Covered Under Fidelis Care Medical Benefit Medications that are administered to a member during an outpatient visit are covered under the member’s medical benefit.  The authorization requests and claims for these medications should be processed through Fidelis Care using the guidelines and tips below, for all Lines of Business. Physician Administered Drugs – medications administered to a member during an outpatient visit: Providers obtain medication via “buy-and-bill” or shipment to their practice site from a vendor of their choosing.