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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

Due to an overwhelming response in October, Fidelis Care will host another Provider Office Hours on November 30th. During the interactive Zoom sessions, Fidelis Care staff will share important information, explain different resources, and answer your questions about our Quality Programs.  In order to reach the intended participants, those that register for this webinar should be in a Quality, Population Health, or Risk Management role. Provider Office Hours – Fidelis Care Quality Programs*  Thursday, November 30th – 3:00PM – 4:00PM - Click here to register. The Quality session

Fidelis Care would like to inform providers of a new CMS requirement regarding member notification when a provider leaves the health plan’s network.  This new rule, which is effective January 1, 2024, requires Fidelis Care to notify members at least 45-days prior to the provider termination date.  To comply with this new requirement, Fidelis Care will require network providers to submit notice of termination/exit from network at least 60 days prior to effective date. Please be advised that the terms of your contract may require a greater notice period. For further questions, please contact your Provider Relations representative. To find your

Fidelis Care is pleased to inform you that the most recent 2023 QARR Non-Compliance Report has been posted on Provider Access Online (provider portal). This information is indicative of all encounter data on file with Fidelis Care as of 9/19/2023.  Please refer to the most recent "Non-Compliance Report" instruction letter to understand the information being provided on each tab of the Excel Spreadsheet.  Please notify any staff involved with quality management and advise that these documents have been posted. If you have any questions, please call the Provider Call Center at 1-888-FIDELIS (1-888-343-3547).

The following sections of the Fidelis Care authorization grids have been updated effective December 1, 2023.   The following code has been added to the Medicare, Medicaid, Essential Plan, and Metal-Level Products Authorization Grids and requires prior authorization: III.        Outpatient surgery: The following services require prior authorization:                          P. Other orthopedic procedures: 23140                                                         The following codes have been added on the Medicaid DME Authorization Grid and require prior authorization: K1036  Supplies for ultra diathermy L1681  Ho bilateral hip abduction                  L5991  Low pros ext osseo connector New Century Health (NCH) will require review of the following codes as of December 1, 2023 for Medicare, Medicaid,