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The following codes on the Evolent/Fidelis Care authorization grid have been updated effective June 1, 2025. The following codes have been removed from the Evolent Radiology Cardiology Utilization Review Matrix and no longer require prior authorization for Wellcare by Fidelis Care, Medicaid, Essential Plans, and Ambetter Metal-Level Products: Transthoracic Echocardiogram - 93307, 93303, 93304, 93306, 93307, 93308, 93320, 93321, 93325, 93356 Chest CT - 71250, 71260, 71270, 0722T CT for Low Dose Lung Cancer Screening - 71271   Visit:  Authorization Requests

Diabetes is the leading cause of chronic kidney disease affecting almost one in three people. Clinical guidelines recommend that all people with diabetes have routine tests to detect kidney disease. However, less than half get the needed tests.  Kidney disease does not show symptoms until later stages of the disease, and this makes early detection the key to managing the disease appropriately. The Kidney Health Evaluation (KED) assesses both kidney function with an estimated glomerular filtration rate (eGFR) and kidney damage with a urine albumin-creatinine (uACR) to develop an appropriate treatment plan. What do you need to do? Order both an estimated glomerular filtration rate

Wellcare and Conversio Health have partnered together to bring providers a comprehensive COPD condition management program to support managing high-risk patients with chronic respiratory conditions—target patient population includes members with a history of ED visits or hospitalizations. Conversio Health services are available to Wellcare by Fidelis Care and Wellcare members. Conversio Health’s expert team of clinical pharmacists, respiratory therapists, and health coaches are focused on giving providers and patients the best quality of service available to help them breathe better.  These services are at no cost to patients and, include: COPD medication therapy optimization Improvement of medication adherence Providing medication affordability,

Earlier this month Fidelis Care notified providers that, pursuant to the regulatory requirements defined in Article 44 of the New York State Public Health Law for all Managed Care Organizations, it was implementing a change to its appeals process by requiring the submission of written member consent.  The change was scheduled to become effective on June 1, 2025.    NYSDOH has informed Fidelis that it is currently reviewing the policy and advised Fidelis Care to postpone its implementation.  Therefore, Fidelis Care is rescinding the implementation of the policy until further notice and will provide an update when more information is available.   For additional

Effective May 1, 2025, the provision of School-Based Health Center (SBHC) and SBHC-Dental (SBHC-D) services will be incorporated into the Mainstream Medicaid Managed Care (MMC) and HIV Special Needs Plan (HIV SNP) benefit package. Therefore, Fidelis Care will be responsible for reimbursing SBHC operators for SBHC services provided to Fidelis Care members. The goal of the transition is to maintain access to these critical SBHC and SBHC-D services while integrating the services into the larger health care delivery system. It is anticipated that the integration of SBHC and SBHC-D services within the existing managed care framework, and coordination of services with