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Effective for Dates of Service in 2026, Payment Year 2027 Beginning with the mid-year risk score run in PY2027, CMS will exclude DOS 2026 diagnosis submissions on unlinked Chart Review Records (CRRs) from Medicare Advantage risk score calculations. Diagnoses not linked to an eligible encounter may no longer be reflected in member risk scores. Wellcare By Fidelis Care’s Operational Approach In response, Wellcare By Fidelis Care will hold all unlinked ASM/Active DX and retrospective chart review submissions until they can be linked to an eligible encounter. To ensure accurate risk score captures, timely claim submission is now essential so diagnoses can be appropriately

Mental health concerns are increasingly being addressed in primary care settings, making it more important than ever for providers to have access to practical tools, expert guidance, and continuing education. That's where Project TEACH can help. Project TEACH (Training and Education for the Advancement of Children's Health) is a New York State-funded program that supports primary care clinicians caring for children, adolescents, and perinatal patients with behavioral health needs. Through education, psychiatric consultation, and referral resources, Project TEACH helps providers build confidence in identifying, evaluating, and managing common mental health conditions within their practices. This fall, Project TEACH is offering a series

Your practice is already doing the work: screenings, chronic condition management, follow-up care, and documentation. The key is making sure that work is captured accurately, so it reflects the quality of care your team provides. The Fidelis Care Clinical Quality Optimization Team partners with providers and office staff to strengthen documentation, improve workflows, close care gaps, and support performance in HEDIS®, QARR, Medicare Star Ratings, and other quality measures. Why Providers Partner with Us Support is tailored to each practice and may include: Workflow, EHR, documentation, and coding optimization Care gap closure and quality measure strategies Provider and staff education based on practice

Fidelis Care will host three Provider Office Hours in October 2026. During the webinars, Fidelis Care staff will be available to share information, provide an overview of provider resources, and answer your questions. Provider Office Hours October 2026 Topic: Fidelis Care – Tools and Resources Overview When:  Thursday, October 8th – 12PM – 1PM EST Click here to register*   Topic: Fidelis Care and Wellcare Quality Programs When:  Wednesday, October 21st – 10:30AM – 11:30AM EST Click here to register*

To support accurate and timely claims processing, providers are reminded not to submit a corrected claim until the original claim has completed processing and reached a finalized status. When a corrected claim is submitted for a claim that has not yet finalized, the submission will be rejected with code 6U – Unfinalized claim; replacement cannot be accepted. This rejection is intended to prevent duplicate or conflicting claim activity while the original claim is still under review in process. What Providers Need to Know Wait for the original claim to finalize before submitting a corrected claim. Corrected claims submitted before the original claim