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Wellcare and Conversio Health have partnered together to bring providers a comprehensive COPD condition management program to support managing high-risk patients with chronic respiratory conditions—target patient population includes members with a history of ED visits or hospitalizations. Conversio Health services are available to Wellcare by Fidelis Care and Wellcare members. Conversio Health’s expert team of clinical pharmacists, respiratory therapists, and health coaches are focused on giving providers and patients the best quality of service available to help them breathe better.  These services are at no cost to patients and, include: COPD medication therapy optimization Improvement of medication adherence Providing medication affordability,

Earlier this month Fidelis Care notified providers that, pursuant to the regulatory requirements defined in Article 44 of the New York State Public Health Law for all Managed Care Organizations, it was implementing a change to its appeals process by requiring the submission of written member consent.  The change was scheduled to become effective on June 1, 2025.    NYSDOH has informed Fidelis that it is currently reviewing the policy and advised Fidelis Care to postpone its implementation.  Therefore, Fidelis Care is rescinding the implementation of the policy until further notice and will provide an update when more information is available.   For additional

Effective May 1, 2025, the provision of School-Based Health Center (SBHC) and SBHC-Dental (SBHC-D) services will be incorporated into the Mainstream Medicaid Managed Care (MMC) and HIV Special Needs Plan (HIV SNP) benefit package. Therefore, Fidelis Care will be responsible for reimbursing SBHC operators for SBHC services provided to Fidelis Care members. The goal of the transition is to maintain access to these critical SBHC and SBHC-D services while integrating the services into the larger health care delivery system. It is anticipated that the integration of SBHC and SBHC-D services within the existing managed care framework, and coordination of services with

The Fidelis Care Provider Relations Department is committed to building strong and lasting relationships with our providers and their staff.  To foster this partnership, we have assigned a Provider Relations Specialist to communicate important information and provide support to our providers. Please be sure to reference our Contact Your Designated Provider Relations Specialist web page if you do not know the name of the specialist assigned to your provider group.  To note, there are times that we adjust territory assignments to better serve our providers, so it important to periodically verify your assigned specialist. If you are unable to determine the identity

Fidelis Care will host three Provider Office Hours in May 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 – May 2025   Topic: Fidelis Care – Back to Basics When:  Thursday, May 8th – 9 AM – 10 AM EST Click here to register*   Topic: Fidelis Care and Wellcare - Quality Programs When:  Wednesday, May 28th – 10 AM – 11

Due to regulatory requirements defined in Article 44 of the New York State Public Health Law for all Managed Care Organizations (MCO), Fidelis Care is implementing changes to our Utilization Management/Authorization Appeals process.  Effective June 1, 2025, Fidelis Care will require providers to adhere to a new procedure related to utilization management/authorization appeals.  As of June 1, 2025, Fidelis Care will require a written member consent to process any provider initiated post-decision appeal review requests.  Member consent can be submitted the following ways: Member or the member’s assigned designee signs the designated area on the Appeal Request Form, which is included