Welcome, Brokers!

Fidelis Care is pleased to inform you that the most recent 2024 QARR/HEDIS Care Gap 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 8/19/2024.  This report provides you with the opportunity to review preventative services for which Fidelis does not show your members as receiving in the measurement period.  We strongly suggest that you review the report for opportunities to either render the service, schedule the service to be done before 12/31/24 or if previously performed, submit supplemental data by 2/1/25.  Please notify

Fidelis Care will host three Provider Office Hours in October 2024. During the webinar, Fidelis Care staff will be available to share information, explain different resources, and answer your questions. Provider Office Hours – October 2024 Topic: Back to Basics – Doing Business with Fidelis Care When:  Thursday, October 10th – 9AM – 10AM EST Click here to register*   Topic: Behavioral Health Overview When:  Thursday, October 24th – 2PM – 3PM EST Click here to register*  

The following sections of the Fidelis Care authorization grids have been updated effective November 1, 2024.   The following codes have been added to the Medicaid DME Authorization Grid:   A4543 Supplies for transcutaneous electrical nerve stimulator, for nerves in the auricular region, per month A4544 Electrode for external lower extremity nerve stimulator for restless legs syndrome

Fidelis Care would like to inform providers of Medicaid requirements when medical records are lost due to an unforeseen event.  Providers whose records have been damaged, lost, or destroyed are required to report that information as soon as practicable, but no later than thirty calendar days after discovery, to the New York State (NYS) Office of the Medicaid Inspector General (OMIG) Self-Disclosure Unit. Failure to report such incidents may result in a determination of overpayment, penalties, and/or sanctions. Please note: Loss/destruction/ corruption/inaccessibility of electronic records due to data corruption, theft, change in data vendor or other issues must also be included

Fidelis Care would like to remind providers of claim submission guidelines regarding Coordination of Benefits (COB) for Child Health Plus, Essential Plan, and Metal-Level products.   Child Health Plus: In accordance with the terms of the Subscriber Contract for Child Health Plus, no coordination of benefits will occur for claims submitted when another carrier is primary. This includes Medicare, any other governmental program, commercial or self-funded policies.   Essential Plan and Health Benefit Exchange: In accordance with the terms of the Subscriber Contracts for the Essential Plan and Health Benefit Exchange, no coordination of benefits will occur for claims submitted when Medicare or any other