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To ensure timely processing and avoid delays, providers should limit all prior authorization fax transmissions to 75 pages or less. Faxes exceeding 75 pages may be delayed or fail to process, which could impact our ability to efficiently and comprehensively process the request.   Tips for Successful Fax Transmission: Assure the fax is 75 pages or less in total, including cover page. Only include information related to the specific request.   Break large documents into multiple faxes (each under 75 pages). Label each part clearly (e.g., “1 of 3,” “2 of 3,” etc.).   Fax Numbers for Utilization Management Authorization Requests: Physical Health - (800)

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

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

In an effort to streamline provider demographic changes and provider termination requests, Fidelis Care has created two new electronic forms for providers to use.  Please use these forms to submit changes under a singular TIN. In order to expedite the request, all fields on the forms are required. If not complete, the request will be delayed. Forms available on fideliscare.org: Provider Demographic Change Request Form   Provider Termination Request Form   Once completed, the forms can be submitted electronically to SMProviderAttestationUpdates@fideliscare.org. In the subject line of the email, please enter Demographic Change/Termination Request for "Your Provider/Group Name" in "Your County" (i.e. Demographic Change Request

Availity experts are hosting several live webinar sessions in the month of August to assist Fidelis Care providers with navigation of Availity Essentials. Space is limited, save your seat today!   Topic Webinar Date Availity Essentials Introduction Monday, August 11th, 3:00 - 4:00 pm EST Authorization Tools

Fidelis Care would like to announce a new Explanation of Benefit (EOB) adjustment reason code that will be applied to claims where Fidelis Care has received a primary carrier payment. New EOB Reason Code Details: CARC Code: 216 – Based on the findings of a review, organization or the payer’s findings. RARC Code: N199 – Additional payment/recoupment approved based on payer-initiated review/audit. These are internal adjustments that reflect the primary carrier’s payment. They do not impact the provider’s Remittance Advice financially and are not considered recoupments.   Primary Carrier Billing and Payments: Medicaid is the payer of last resort and should always be