Welcome, Brokers!

Access to quality care is essential to reducing health disparities and improving the quality and length of life for all New Yorkers.

The New York State Department of Health (NYSDOH) and CMS require that specific Access and Availability Standards be met by Primary Care Providers (PCPs), OB/GYNs, Specialists, and Behavioral Health Providers.

To ensure compliance, Fidelis Care conducts regular Access & Availability surveys to confirm providers meet these state-mandated standards for all Fidelis Care members.

The survey evaluates:

• Timeliness of appointment scheduling by appointment type
• Accuracy of provider directory listings
• Responsiveness of phone systems and office staff

Common issues leading to non-compliance include:

• Appointment times that do not meet state guidelines
• Closed provider panels
• Inaccurate or outdated phone information
• Offices closed or unreachable during business hours

To remain in compliance providers must:

• Keep contact information accurate and up to date
• Ensure appointment availability meets state standards
• Maintain patient access procedures during business hours

To help your office prepare for upcoming surveys, we’ve created two new tip sheets:

• General Medical Access & Availability Tip Sheet
• Behavioral Health Access & Availability Tip Sheet

If you have questions or need assistance, please contact your Fidelis Care Provider Engagement Account Manager.  To find your designated representative, visit: Contact Your Designated Provider Relations Specialist.