Today
• Posted by Provider Relations
The following section of the Fidelis Care authorization grids have been updated effective May 1, 2025.
The following codes have been updated on the Medicare, Medicaid, Essential Plan, and Ambetter Metal-Level Products Authorization Grids and require prior authorization:
III. Outpatient surgery: The following services require prior authorization:
D. Skin surgery and other dermatological procedures:
11730 requires an authorization when billed with REV codes 0360, 0361 and 0490
Only the following codes require authorization for any place of service: A2030, A2031, A2032, A2033, A2034, A2035, 11200, 11201, 11719, 15769 - 15829, 17340-17999, Q4354, Q4355, Q4356, Q4357, Q4358, Q4359, Q4360, Q4361, Q4362, Q4363, Q4364,
Last Week
• Posted by Provider Relations
Fidelis Care would like to alert providers of an important change to the NYRx Pharmacy Program’s coverage, effective 04/01/2025.
Changes to Over-the-Counter Medications:
Beginning 04/01/2025, per the Commissioner’s recommendation, NYRx will no longer cover the following over-the-counter items:
• Oxymetazoline containing OTC products (Afrin®)
• Phenylephrine-containing OTC products (Sudafed PE®)*
• Simethicone-containing OTC products (Gas-X)
• Glucose tablets
• Bacitracin-containing OTC products
• Neomycin-containing OTC products
• Multivitamins for members 21 and older**
*This does not include pseudoephedrine (Sudafed®) containing products, which will continue to be covered.
**This does not include prescription-only prenatal vitamins, which will continue to be covered.
How this may impact our membership:
If members were filling
Last Week
• Posted by Provider Relations
Fidelis Care’s Pharmacy Services would like to provide a reminder and clarity on how to submit claims for medications billed under the member’s medical benefit, as well as the appropriate Servicing Provider to document when submitting a Pharmacy Prior Authorization request for such medications.
A Pharmacy Prior Authorization Request form can be found on the Fidelis Care website within the Utilization Management Programs section.
Documenting the Appropriate Serving Provider
When submitting a Pharmacy Prior Authorization, the Servicing Provider should be the individual provider, facility, or pharmacy who will be supplying and subsequently billing for the supply of the requested medication. This should be
2025/3/13
• Posted by Provider Relations
You asked and we listened! Fidelis Care is pleased to announce that claim status letters are now available on Provider Access Online, Fidelis Care’s Provider Portal, in the File Download section.
The letters available on Fidelis Care’s Provider Portal now include:
Closed Claim Letter
Claim Appeal Letter
To access claim letters:
Use the menu on the left of the Provider Access Online home page to navigate to the File Downloads section.
On the File Download page can search by File Type and File Created date range.
Click on the letter you would like to download.
To check the status of a claim:
Use
2025/3/13
• Posted by Provider Relations
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
2025/3/12
• Posted by Provider Relations
The Department of Health has partnered with Public Partnerships LLC (PPL) as the single Statewide Fiscal Intermediary (SFI) for the Consumer Directed Personal Assistance Program (CDPAP). All Consumers and Personal Assistants in the CDPAP must change to PPL by March 28, 2025.
To avoid an interruption of services, members receiving CDPAP services must contact PPL as soon as possible. Providers are encouraged to share this enrollment information with all members receiving CDPAP Services.
How to Register with PPL:
·Option 1: Transition Over the Phone
Call the customer support center at 1-833-247-5346, and they will assist the Consumers through the process. Also available: 1-833-278-4829 (Arabic),
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