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Fidelis Care would like to remind providers of New York State Medicaid reimbursement policy for x-ray examinations performed during the same visit.  This policy applies to the following lines of business: Medicaid CHP Essential Plan Ambetter from Fidelis Care Per NYS guidance: Multiple X-rays during the same visit: Reimbursement will be limited to the greater fee, plus 60% of the lesser fee(s). For more information, please reference the eMedNY New York State Medicaid Provider Procedure Code Manual. If you have any additional questions, or if we can be of assistance in any way, please contact your Fidelis Care

Fidelis Care is committed to supporting continued access to telehealth services. Although Congress only authorized Medicare reimbursement for expanded telehealth services through September 30, 2025, Wellcare By Fidelis Care will extend coverage for Medicare telehealth benefits through 2026.   There will be no disruption in coverage to our Wellcare By Fidelis Care members or providers during 2025 and 2026. Providers should continue to offer and bill for telehealth visits as they normally would.   Wellcare By Fidelis Care’s Medicare plans have benefits aligned with the flexibilities that have been previously offered as supplemental benefits. As a result, even after the expiration of Medicare flexibilities,

The following sections of the Fidelis Care authorization grids have been updated effective December 1, 2025.             The following code has been added to the Medicaid, Medicare, Essential Plan, and Metal-Level Products Authorization Grids and requires prior authorization: V.        Outpatient and DME Services: The following services require prior authorization: A.  Diagnostic testing                                  6.  Proprietary Laboratory Analysis - 0340U    The following code has been added on the Medicaid, Medicare, Essential Plan, and Metal-Level Products Authorization Grids and requires prior authorization: S0013      esketamine (Spravato)   The following has been updated on the Metal-Level Products Authorization Grid: The Pharmacy section of the Metal-Level Authorization Grid has been updated to include an indicator for drugs

Fidelis Care is initiating a transition process for providers to identify members who are currently receiving group and family therapy services, and who will continue treatment beyond November 1, 2025, along with current frequency and duration. The below FAQ was created to address provider questions related to the updated authorization requirements, which are in effect for dates of service of November 1, 2025, and thereafter. Providers should submit their member rosters to qhcmbh@fideliscare.org using format outlined below, no later than October 31, 2025. This information will ensure a smooth transition for members engaged in treatment.   As a reminder: Effective November 1, 2025, the

NY State of Health has announced upcoming changes to the Essential Plan 5, effective July 1, 2026. To help current enrollees prepare, Fidelis Care members have started receiving official notifications from the state outlining these updates. To support you in addressing patient questions, Fidelis Care has compiled a list of frequently asked questions (FAQs) to guide your conversations and provide clarity. FAQs I have patients saying they received a letter about their Essential Plan coverage ending. What is going on? Essential Plan 5 members recently received a letter from NY State of Health notifying them that EP5 will end on July 1, 2026.

Fidelis Care will host three Provider Office Hours in November 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 – November 2025   Topic: Fidelis Care – Back to Basics When:  Thursday, November 13th – 9AM – 10AM EST Click here to register*   Topic: Fidelis Care and Wellcare - Quality Programs When:  Wednesday, November 19th – 10 AM – 11 AM EST