Yesterday
• Posted by Provider Relations
The following sections of the Fidelis Care authorization grids have been updated effective October 1, 2025.
The following codes have been updated on the Medicaid, CHP, Essential Plan, Ambetter Metal-Level Plans, and Medicare Authorization Grids and require prior authorization:
C9305 nipocalimab-aahu (Imaavy)
C9306 telisotuzumab vedotin-tllv (Emrelis)
J0614 treosulfan (Grafapex)
J1370 esomeprazole injection
J1809 fosdenopterin
J3402 remestemcel-l-rknd (Ryoncil)
J3403 Revakinagene taroretcel-lwey (Encelto)
J7173 concizumab-mtci (Alhemo)
J7174 fitusiran (Qflitlia)
J9011 datopotamab deruxtecan-dlnk (Datroway)
Q5154 omalizumab-igec (Omlyclo)
Q5155 aflibercept-jbvf (Yesafili)
Q5156 tocilizumab-anoh (Avtozma)
Q5157 denosumab-bmwo (Stoboclo/Osenvelt)
Q5158 denosumab-bnht (Bomyntra/Conexxence)
Q5159 denosumab-dssb (Ospomyv/Xbryk)
For Medicaid, CHP, Essential Plan, Ambetter Metal-Level Plans, and Medicare, the following codes have been added to the list of drugs that require NCH review:
J9011 datopotamab deruxtecan-dlnk (Datroway)
Q5156 tocilizumab-anoh (Avtozma)
Q5157 denosumab-bmwo (Stoboclo/Osenvelt)
Q5158 denosumab-bnht (Bomyntra/Conexxence)
Q5159 denosumab-dssb (Ospomyv/Xbryk)
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Last Week
• Posted by Fidelis Care
Гранты, направленные на поддержку инновационных программ профилактической медицинской помощи в сельских сообществах
ЛОНГ-АЙЛЕНД-СИТИ, НЬЮ-ЙОРК (10 сентября, 2025 г.) Компания Fidelis Care, поставщик планов медицинского страхования, насчитывающих более 2,4 миллиона участников по всему штату Нью-Йорк, и компания Centene Corporation открыли прием заявок на участие в программе грантов на развитие здравоохранения в сельской местности на 2025 год.
Last Week
• Posted by Provider Relations
Fidelis Care would like to inform providers of a significant development impacting COVID-19 vaccine access across New York State.
On Friday, Governor Kathy Hochul signed an executive order declaring a disaster emergency to ensure near-universal access to the latest COVID-19 vaccines. This order, effective through October 5, 2025, enables pharmacists to prescribe and administer the 2025–2026 COVID-19 vaccine formulations to patients ages 3 and older.
While the FDA has only approved the latest vaccine formulations for individuals at high risk of severe illness or those aged 65 and older, the executive order allows broader access in anticipation of the upcoming respiratory virus season.
Key Points
Last Week
• Posted by Provider Relations
Fidelis Care is pleased to announce that a new Provider Bulletin is now available. The bulletin features updates on important initiatives and the latest news of interest to our provider community.
Articles in this issue:
· Championing Mental Health: Early Intervention is Key
· Important Reminders About HIV Prevention and Testing
· Supporting Maternal Health for Healthy Pregnancies and Babies
· Encourage Preventive Cancer Screenings
· Help Your Patients of All Ages Stay Active!
· Access and Availability Standards
Please download Fidelis Care Provider Bulletin – Volume 11, Issue 3.
To view our Provider Bulletin Library, please visit: Provider Bulletins.
04.09.2025
• Posted by Provider Relations
As part of an ongoing series, Fidelis Care will highlight some best practices we learn from our partners across the State in the interest of providing the best experience possible for our members.
For this month’s highlight, we’re looking at the Teach-Back Method, a communication technique where providers ask patients to repeat back key information in their own words. This helps confirm understanding, identify confusion, and reinforce learning—especially around diagnoses, medications, and follow-up care.
How It Works
After explaining a concept or instruction, you may want to say: “I want to make sure I explained this clearly. Can you tell me how you’ll manage
03.09.2025
• Posted by Provider Relations
The following sections of the Fidelis Care authorization grids have been updated effective October 1, 2025.
The following code has been added to the Medicaid DME Authorization grid and requires prior authorization for Medicaid, Medicare, Essential Plan, and Metal-Level lines of business:
L1907 Afo supramalleolar custom
The following code has been added on the Medicaid, Medicare, Essential Plan, and Metal-Level Products Authorization Grids and requires prior authorization:
J9306 pertuzumab (Perjeta)
The following code has been added on the Medicaid, Essential Plan, and Metal-Level Products Authorization Grids and requires prior authorization:
J9308 ramucirumab (Cyramza)
The following code has been added on the Medicaid and Metal-Level Products Authorization
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