29.03.2024
• Posted by Provider Relations
Beginning March 2, 2024, current enrollees in Qualified Health Plans (Ambetter from Fidelis Care) who are within 200-250% FPL were notified via letter from NY State of Health about the expansion of Essential Plan (EP) coverage in New York State. Members that now qualify for Essential Plan coverage will automatically be moved from their Qualified Health Plan to Essential Plan 200-250, effective April 1, 2024.
In addition to the Essential Plan Expansion, effective April 1, 2024, NYS will be implementing the EP Pregnancy Choice Provision. Individuals who are currently in EP and who report being pregnant will remain EP eligible, instead
25.03.2024
• 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
19.03.2024
• Posted by Provider Relations
Fidelis Care is pleased to inform you that the medical record request letter and details for 2023 HEDIS/QARR have been posted on our Provider Portal, Provider Access Online (PAO). Please review these materials and send the requested documentation to Fidelis Care as soon as possible. Thank you in advance for your cooperation on this important matter. Should you have any questions or concerns, please do not hesitate to contact Fidelis Care’s Provider Call Center at 1-888-FIDELIS (1-888-343-3547).
As part of the New York State Quality Assurance Reporting Requirements (QARR), National Committee for Quality Assurance (NCQA), and HEDIS reporting requirements for the Centers
13.03.2024
• Posted by Provider Relations
As of January 1, 2024, Fidelis Care has partnered with MCG Health to implement the MCG Cite Guideline Transparency Tool. Providers can access this feature through the Fidelis Care Provider Portal.
With the MCG Cite Guideline Transparency Tool, Fidelis Care shares clinical indications with providers. The tool is a secure resource that helps meet regulations around transparency for care delivery.
Benefits include:
Transparency: Delivers industry-leading medical determination transparency.
Access: Allows the review of MCG clinical evidence used by payers to support
member care decisions.
Security: Ensures easy and flexible access via secure web access.
This Quick Reference Guide details how to
12.03.2024
• Posted by Provider Relations
Providers, please remember to review content available in Provider Access Online (Fidelis Care's secure Provider Portal) and the rest of this Provider section of the Fidelis Care website. Both locations are excellent resources of information about our programs and services. One example of a resource contained in this site is our Provider Manual. The Provider Manual contains details about our credentialing processes and our member rights and responsibilities statement. It also includes information about the clinical criteria used in utilization management (UM) decision-making, our pharmacy authorization processes, and Fidelis Care's policy statement on how coverage decisions are made.
Other items you will find in
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