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Doctors play an important role in keeping people healthy. They provide expert care, guidance, and compassion to patients every day. In honor of National Doctors’ Day, Fidelis Care thanks doctors everywhere who make a difference in our communities. We visited with doctors from provider partners Compassionate Family Medicine in Syracuse, Polaris Healthcare Visiting Docs in Spring Valley, and WNY Medical in Buffalo to get their thoughts in observance of National Doctors’ Day.   Fidelis Care: What inspired you to become a doctor?   Dr. Riffat Sadiq, WNY Medical: From a young age, I enjoyed helping people to take care of themselves. I had my

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,

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

Providers, please remember to review content available in Provider Access Online (Fidelis Care's secure Provider Portal) and the rest of this Provider section of the Fidelis Care website.  Both locations are excellent resources of information about our programs and services.  One example of a resource contained in this site is our Provider Manual.  The Provider Manual contains details about our credentialing processes and our member rights and responsibilities statement.  It also includes information about the clinical criteria used in utilization management (UM) decision-making, our pharmacy authorization processes, and Fidelis Care's policy statement on how coverage decisions are made.   Other items you will find in

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

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