31.10.2023
• Posted by Provider Relations
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,
16.10.2023
• Posted by Provider Relations
The Fidelis Care Provider Relations Department is committed to building strong and lasting relationships with our providers and their staff. To foster this partnership, we have assigned a Provider Relations Specialist to communicate important information and provide support to our providers. If you do not know the name of your specialist, please visit our new Contact Your Designated Provider Relations Specialist web page.
From this page, you can identify your assigned Specialist by using the regional drop-down menus. If you are unable to determine the identity of your Specialist, please email the Contact_PR@fideliscare.org mailbox, and a Provider Relations team member will
10.10.2023
• Posted by Provider Relations
Effective April 1, 2023, Medicaid Managed Care Plan members, including youth placed in foster care, pharmacy benefits transitioned to NYRx, the Medicaid Pharmacy program.
The pharmacy benefit requirements for youth placed in foster care include, but are not limited to, rapid replacement of medically necessary prescriptions and transitional fills for youth newly placed in foster care. Physicians administering drugs, durable medical equipment, prosthetics, orthotics, and supplies are still covered by Fidelis Care when billed as a medical or institutional claim as outlined in The Pharmacy Procedure Code Manual.
As a reminder, upon placement into Foster Care, the youth is required to
06.10.2023
• Posted by Provider Relations
The METS program is an integrated, whole health approach to support members with significant behavioral health challenges. It includes behavioral health, medical, therapeutic, pharmacy, and supplemental services. METS’ purpose is to focus on the recovery and resiliency of each person. The goal is to help members remain in their community. Members are internally identified using claims history over a 12-month period. If you have a patient identified for the program, a METS Clinical Liaison will reach out to you to discuss the member’s treatment plan and progress.
The METS team partners with both the provider and the member to ensure the member achieves
29.09.2023
• Posted by Provider Relations
Fidelis Care would like to share some exciting news with you regarding the brand name of our Qualified Health Plans (QHPs).
As of January 1, 2024, all Fidelis Care QHPs will be known as Ambetter from Fidelis Care. Fidelis Care’s Medicaid Managed Care (MMC), Child Health Plus (CHP), Managed Long Term Care (MLTC), Health and Recovery Plan (HARP), and Essential Plan (EP) will continue under the Fidelis Care brand.
This fall, you will begin to receive materials with the new Ambetter from Fidelis Care branding as we transition to the new name for our QHP products.
You do not need to take any
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