Welcome, Brokers!

Fidelis Care is pleased to announce a new addition to the Provider Manual—the Quality Policy. The policy seeks to set forth the core quality requirements for any provider contracted with Fidelis Care. Those requirements include 1) a minimum Medicare Stars rating of 2.5 or higher, 2) ensuring that at least 50% of the Medicaid HEDIS measures perform at the 75^th percentile or higher, 3) 100% medical record submissions for HEDIS & Risk Adjustment purposes, and 4) adherence to digital methods of records submission, or allowing remote access when otherwise not covered. Failure to meet those core requirements will lead to potential termination of the contract.

Please note that Fidelis Care has made investments on behalf of providers to meet these requirements, including participation as of November 2025 with 4 of the 6 major Regional Health Information Organizations (RHIOs)—the other 2 will be added in 2026. Additionally, Fidelis Care has staff at its disposal to help with any Supplemental Data submissions (SuDS), along with support for launching bi-connected EMRs (e.g., Epic Payor Platform).

Should you have any questions about the new Quality Policy, please contact your Quality Improvement Specialist.  To find your designated representative, please visit our Quality Information website.