Welcome, Brokers!

Fidelis Care would like to remind our providers of plan changes for Ambetter From Fidelis Care and Essential Plans in response to a recent NY Senate Bill addressing copayments for PrEP and PEP medications.  The in-network cost share for members will be waived for medications used for PrEP and PEP, provided that an appropriate ICD-10 diagnosis code is documented on the prescription sent to the Pharmacy. Below are updated lists of medications indicated for PrEP and/or PEP. PrEP Medications: Descovy Tab 200-25 MG Apretude INJ 600 MG/3 ML Tuvada 200-300MG; Emtricitabine-tenofovir 200-300MG PEP Medications: Tivicay Tab 50 MG Isentress Tab 400 MG Darunavir

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

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

Fidelis Care would like to remind providers that Urgent and Concurrent Authorization Requests cannot be submitted through the Provider Portal, as this will cause delays in processing.   To expedite the processing of Urgent, providers should submit requests through: Availity Essentials, or Fax Urgent requests directly to: (800) 860-8720, and label the request as “Urgent”   Urgent Concurrent Authorization Requests and Concurrent Authorization Requests should be submitted by: Faxing requests directly to: (800) 860-8720, and labeling the request as “Concurrent”   To register for an Availity Essentials account, visit Register and Get Started with Availity Essentials.   For additional questions, or if we can be of assistance in any

LONG ISLAND CITY, NY (June 10, 2025) Fidelis Care, a statewide health plan with more than 2.4 million members in New York State and a Centene Corporation company, has opened the application process for its 2025 maternal health grant program. The grants, open to healthcare providers and community-based organizations in New York, aim to fund programs that support innovative strategies in postpartum care and maternal mental health. The application is available at fideliscare.org/maternal-grant. The deadline to apply is 5 p.m. July 8, 2025.     Postpartum care and maternal mental health are critical components of long-term health and well-being for new mothers and their families.