Today
• Posted by Provider Relations
Fidelis Care is pleased to announce that providers now have access the Availity Clinical Quality Validation (CQV) tool designed to help providers close care gaps quickly and accurately. Through the Availity Essentials portal, CQV streamlines documentation and improves quality scores while reducing administrative burden.
What is CQV?
Clinical Quality Validation (CQV) is an Availity Essentials application that helps providers:
· Monitor targeted care gaps/measures for the measurement year.
· View and respond to payer requests for clinical/medical data.
· Improve quality scores and reduce administrative burden.
Benefits
· Streamlined workflow for care gap closure.
· Faster access to clinical data.
· Enhanced provider experience across multiple markets.
Availity-led Training for
Yesterday
• Posted by Provider Relations
Fidelis Care has received notice from the Office of the Medicaid Inspector General (OMIG) of new compliance program requirements for Medicaid participating providers.
Effective April 2020, for New York State (NYS) Social Services Law (SSL) §363-d, and effective December 28, 2022, for the corresponding regulations at 18 New York Codes, Rules and Regulations (NYCRR) Subpart 521-1, NYS Medicaid providers shall adopt, implement, and maintain effective compliance programs aimed at detecting fraud, waste, and abuse in the NYS Medicaid program.
Who is Required to Have a Compliance Program?
NYS Social Services Law (SOS) § 363-d and Title 18 of the New York Codes, Rules
Yesterday
• Posted by Provider Relations
Recent changes for the 2026 Health Insurance Marketplace may affect eligibility for members at health plans across the nation. One important update is the way in which current and future Marketplace beneficiaries will apply for Advanced Premium Tax Credits (APTCs) in 2026 and beyond. That’s why Ambetter from Fidelis Care is sharing a quick reminder with our participating providers on the best way to confirm Member eligibility in the Availity Essentials platform and other secure portals.
Grace Periods for Members receiving an APTC
Members enrolled in a Marketplace health plan are responsible for completing their premium payments each month. Members that do not
Yesterday
• Posted by Provider Relations
Annual cultural competency training for participating providers is required by the New York State Department of Health. At this time, The New York State DOH will only accept the approved training offered by the United States Department of Health and Human Services (HHS), Office of Minority Health education program, Think Cultural Health, to fulfill the requirement for provider annual cultural competency training.*
Once the cultural competency training has been completed, providers need to verify completion of the program by emailing the Cultural Competency Attestation Form to:
CulturalCompetencyTrainingAttestation@fideliscare.org.
The required Cultural Competency Training needs to be completed annually by December 31st. Providers that completed
Friday
• Posted by Provider Relations
Access to quality care is essential to reducing health disparities and improving the quality and length of life for all New Yorkers.
The New York State Department of Health (NYSDOH) and CMS require that specific Access and Availability Standards be met by Primary Care Providers (PCPs), OB/GYNs, Specialists, and Behavioral Health Providers.
To ensure compliance, Fidelis Care conducts regular Access & Availability surveys to confirm providers meet these state-mandated standards for all Fidelis Care members.
The survey evaluates:
Timeliness of appointment scheduling by appointment type
Accuracy of provider directory listings
Responsiveness of phone systems and office staff
Common issues leading to non-compliance include:
Appointment
Thursday
• Posted by Provider Relations
We want to inform you that we are currently experiencing high call volumes in our Provider Contact Center, which are impacting wait times.
We understand the importance of timely support and appreciate your patience during this period. Please consider using the Fidelis Care Provider Portal or Availity which offer convenient self-service options including but not limited to: claim status, authorization status and member eligibility.
We will provide updates when available. Thank you for your understanding and continued partnership.
If you have any questions, please contact your Fidelis Care Provider Engagement Account Manager. To find your designated representative, please click here.
Fidelis Care is proud to be
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