Monday
• Posted by Provider Relations
As you know, Fidelis Care relies upon the receipt of membership information from the New York State Department of Health (SDOH) prior to issuing capitation payments. The date for receiving this information from the SDOH varies from month to month. In certain months, the availability of data may be delayed as much as one week. Nevertheless, Fidelis Care has historically made capitation payments as close to the first of each calendar month as possible.
Presented below is Fidelis Care’s 2026 capitation check and Electronic Funds Transfer (EFT) schedule. Please refer to this to determine the timing of your monthly payment. Over
Monday
• Posted by Provider Relations
Fidelis Care will host three Provider Office Hours in January 2026. During the webinar, Fidelis Care staff will be available to share information, provide an overview of provider resources, and answer your questions.
Provider Office Hours – January 2026
Topic: Fidelis Care – Back to Basics
When: Thursday, January 8th – 9AM – 10AM EST
Click here to register*
Topic: Fidelis Care and Wellcare Quality Programs
When: Wednesday, January 21st – 10AM – 11AM EST
Click here to register*
Monday
• Posted by Provider Relations
The following sections of the Fidelis Care authorization grids have been updated effective February 1, 2026.
The following codes have been added to the Medicaid DME Authorization Grid and require prior authorization:
E0766 Electrical stimulation device used for cancer treatment, includes all accessories, any type
E2606 Positioning wheelchair seat cushion, width 22 inches or wider
Visit: Authorization Grids
Monday
• Posted by Provider Relations
Fidelis Care is pleased to announce that a new Provider Bulletin is now available. The bulletin features updates on important initiatives and the latest news of interest to our provider community.
Articles in this issue:
· Help Prevent the Flu: Encourage Vaccination
· COVID-19 Reminder
· Cardiovascular Disease and Statin Therapy
· Antibiotic Stewardship Starts with Awareness
· CDC Recommendations for STI Treatment
Please download Fidelis Care Provider Bulletin – Volume 11, Issue 4.
To view our Provider Bulletin Library, please visit: Provider Bulletins.
2025/12/12
• Posted by Provider Relations
Fidelis Care would like to remind providers of the upcoming change to Medicaid pharmacy benefits for phosphate binders used by dialysis patients.
Effective January 1, 2026, phosphate binder prescription drugs for New York Medicaid members utilizing dialysis will no longer be covered as a pharmacy benefit via NYRx, the Medicaid Pharmacy Program, and must be provided by the dialysis clinic as part of the bundled dialysis payment. See below for a list of Phosphate Binders:
Auryxia™
Calcium acetate
Ferric citrate
Fosrenol®
Lanthanum carbonate
Renvela®
Sevelamer carbonate
Sevelamer HCl
Velphoro®
Xphozah®
For additional information, please see the following communications from the New York
2025/12/11
• Posted by Provider Relations
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
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