Welcome, Brokers!

Fidelis Care will host three Provider Office Hours in October 2025. 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 2025   Topic: Fidelis Care Tools & Resources Overview When:  Thursday, October 9th – 12PM – 1PM EST Click here to register*   Topic: Fidelis Care and Wellcare - Quality Programs When:  Wednesday, October 15th – 10 AM – 11 AM EST

Access to quality care is important to eliminate health disparities and increase the quality and years of healthy life for all New Yorkers. The NYSDOH requires that certain Access and Availability Standards be met by PCPs, OB/GYNs, specialists, and behavioral health providers where applicable. Click here to view the full list of standards, including situations and timeframes.   For additional questions, or if we can be of assistance in any way, please contact your Fidelis Care Provider Engagement Account Manager. To find your designated representative, please click here. 

The following sections of the Fidelis Care authorization grids have been updated effective October 1, 2025.             The following codes have been updated on the Medicaid, CHP, Essential Plan, Ambetter Metal-Level Plans, and Medicare Authorization Grids and require prior authorization: C9305      nipocalimab-aahu (Imaavy) C9306      telisotuzumab vedotin-tllv (Emrelis) J0614      treosulfan (Grafapex) J1370      esomeprazole injection J1809      fosdenopterin J3402      remestemcel-l-rknd (Ryoncil) J3403      Revakinagene taroretcel-lwey (Encelto) J7173      concizumab-mtci (Alhemo) J7174      fitusiran (Qflitlia) J9011      datopotamab deruxtecan-dlnk (Datroway) Q5154     omalizumab-igec (Omlyclo) Q5155     aflibercept-jbvf (Yesafili) Q5156     tocilizumab-anoh (Avtozma) Q5157     denosumab-bmwo (Stoboclo/Osenvelt) Q5158     denosumab-bnht (Bomyntra/Conexxence) Q5159     denosumab-dssb (Ospomyv/Xbryk)   For Medicaid, CHP, Essential Plan, Ambetter Metal-Level Plans, and Medicare, the following codes have been added to the list of drugs that require NCH review: J9011      datopotamab deruxtecan-dlnk (Datroway) Q5156     tocilizumab-anoh (Avtozma) Q5157     denosumab-bmwo (Stoboclo/Osenvelt) Q5158     denosumab-bnht (Bomyntra/Conexxence) Q5159     denosumab-dssb (Ospomyv/Xbryk)   Visit: 

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