2025/9/29
• Posted by Provider Relations
The role of primary care providers in preventing vaccine-preventable diseases includes more than administering vaccines. Timely documentation in New York’s immunization registries (New York State Immunization Information System (NYSIIS) for providers outside New York City, and the Citywide Immunization Registry (CIR) for providers within New York City) is essential to protecting children and supporting public health.
Why Timely Reporting Matters
Accurate updates to NYSIIS and CIR:
Ensure continuity of care
Prevent missed or duplicate vaccinations
Support public health surveillance
Improve office efficiency
Comply with New York State law (reporting required within 14 days)
The Value of Timely Vaccination
Vaccines are most effective when given
2025/9/29
• Posted by Provider Relations
Fidelis Care’s Pharmacy Services would like to provide clarification on how medications are covered under member’s medical and pharmacy benefits.
Medications Covered Under Fidelis Care Medical Benefit
Physician Administered Drugs – medications administered to a member during an outpatient visit
Providers obtain medication via “buy-and-bill” or shipment to their practice site from a vendor of their choosing.
Coverage is dictated by Fidelis Care Authorization Grids, Prior Authorization Lookup Tool and/or Evolent Specialty Services (formerly NCH) Authorization Grids (Oncology Regimen Specific).
Medical Benefit Authorization Grids are plan specific.
If a medication is listed on one of the above authorization grids/tools, an authorization
2025/9/26
• Posted by Provider Relations
Fidelis Care will host three Provider Office Hours in October 2025. During the webinars, Fidelis Care staff will be available to share information, provide an overview of provider resources, and answer your questions.
Provider Office Hours – October 2025
Topic: Fidelis Care Tools & Resources Overview
When: Thursday, October 9th – 12PM – 1PM EST
Click here to register*
Topic: Fidelis Care and Wellcare - Quality Programs
When: Wednesday, October 15th – 10 AM – 11 AM EST
2025/9/17
• Posted by Provider Relations
The following sections of the Fidelis Care authorization grids have been updated effective October 1, 2025.
The following codes have been updated on the Medicaid, CHP, Essential Plan, Ambetter Metal-Level Plans, and Medicare Authorization Grids and require prior authorization:
C9305 nipocalimab-aahu (Imaavy)
C9306 telisotuzumab vedotin-tllv (Emrelis)
J0614 treosulfan (Grafapex)
J1370 esomeprazole injection
J1809 fosdenopterin
J3402 remestemcel-l-rknd (Ryoncil)
J3403 Revakinagene taroretcel-lwey (Encelto)
J7173 concizumab-mtci (Alhemo)
J7174 fitusiran (Qflitlia)
J9011 datopotamab deruxtecan-dlnk (Datroway)
Q5154 omalizumab-igec (Omlyclo)
Q5155 aflibercept-jbvf (Yesafili)
Q5156 tocilizumab-anoh (Avtozma)
Q5157 denosumab-bmwo (Stoboclo/Osenvelt)
Q5158 denosumab-bnht (Bomyntra/Conexxence)
Q5159 denosumab-dssb (Ospomyv/Xbryk)
For Medicaid, CHP, Essential Plan, Ambetter Metal-Level Plans, and Medicare, the following codes have been added to the list of drugs that require NCH review:
J9011 datopotamab deruxtecan-dlnk (Datroway)
Q5156 tocilizumab-anoh (Avtozma)
Q5157 denosumab-bmwo (Stoboclo/Osenvelt)
Q5158 denosumab-bnht (Bomyntra/Conexxence)
Q5159 denosumab-dssb (Ospomyv/Xbryk)
Visit:
2025/9/10
• Posted by Fidelis Care
旨在支援農村社區創新型預防性保健服務的補助金
紐約長島市（2025年9月10日）飛達利斯保健是一個在全州營運的健康計劃，在紐約州擁有逾240萬名會員，是Centene公司的旗下公司，已啟動2025年鄉村健康補助金計劃的申請流程。該批補助金旨在支援醫療保健服務提供者及社區組織，這些組織致力於構思並打造創新性解決方案，以提升紐約州各農村社區的預防性保健水準。該申請表可在fideliscare.org/rural-grant上找到。申請截止日期為2025年10月3日。
2025/9/9
• Posted by Provider Relations
Fidelis Care would like to inform providers of a significant development impacting COVID-19 vaccine access across New York State.
On Friday, Governor Kathy Hochul signed an executive order declaring a disaster emergency to ensure near-universal access to the latest COVID-19 vaccines. This order, effective through October 5, 2025, enables pharmacists to prescribe and administer the 2025–2026 COVID-19 vaccine formulations to patients ages 3 and older.
While the FDA has only approved the latest vaccine formulations for individuals at high risk of severe illness or those aged 65 and older, the executive order allows broader access in anticipation of the upcoming respiratory virus season.
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