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 2021 capitation check and Electronic Funds Transfer (EFT) schedule. Please refer to this to determine the timing of your monthly payment. Over the years, we
Fidelis Care is pleased to announce we have partnered with New Century Health (NCH) to implement a new oncology prior authorization program, Oncology Pathway Solutions. The program will make it easier for providers to effectively deliver quality patient care.
Effective November 2, all oncology-related chemotherapeutic medications and supportive agents will require prior authorization from NCH before being dispensed at a pharmacy or administered in a physician’s office, outpatient hospital, or ambulatory setting. This requirement applies for Medicaid Managed Care, Essential Plan, and Qualified Health Plan members, ages 18 and older.
Prior authorization can be requested by:
· Visiting NCH’s Web portal at my.newcenturyhealth.com, or
· Calling 1-888-999-7713, option
Please refer to this link: Important Updates Regarding Coronavirus COVID-19, for authorization and coding guidelines related to the COVID-19 Pandemic.
The following sections of the Fidelis Care authorization grids have been updated effective February 1, 2021
Authorization for podiatric services has been amended on the Medicaid, Essential Plan, and Metal Level Plan authorization grids in Outpatient and DME Services as follows:
G. Podiatry Services
Authorization is no longer required for podiatric services however, authorization requirements will apply to individual services that are indicated on this grid and rendered by podiatrists.
The following services apply to Medicaid, Essential Plan, and Metal Level Plans and require
Coronavirus disease 2019 is a new and emerging illness in the United States. The virus causes a disease called COVID-19 that can lead to fever, cough and shortness of breath. There are thousands of confirmed cases in a growing number of countries internationally, and the virus is now spreading in the United States, including New York State. New information, obtained daily, further informs the risk assessment, treatment options, and next steps.
Fidelis Care is closely monitoring the developments across New York State and is following COVID-19 guidance from the New York State Department of Health (SDOH) and Department of Financial Services
The following codes have been published as of November 10, 2020. However, they will not be billable until the specific vaccine receives official EUA approval. Similar to other COVID-19 services, the vaccines will be offered at no cost to your patients.
Fidelis Care is closely following advancements in the prevention and treatment of COVID-19, including vaccinations. As a healthcare provider, you will play an integral role as COVID-19 vaccines become available. We want to update you on important new information about vaccine coverage.
To prepare for vaccine administration, the Centers for Medicare and Medicaid (CMS) have published billing guidance. The following codes