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The following sections of the Fidelis Care authorization grids have been updated effective December 1, 2025.             The following code has been added to the Medicaid, Medicare, Essential Plan, and Metal-Level Products Authorization Grids and requires prior authorization: V.        Outpatient and DME Services: The following services require prior authorization: A.  Diagnostic testing                                  6.  Proprietary Laboratory Analysis - 0340U    The following code has been added on the Medicaid, Medicare, Essential Plan, and Metal-Level Products Authorization Grids and requires prior authorization: S0013      esketamine (Spravato)   The following has been updated on the Metal-Level Products Authorization Grid: The Pharmacy section of the Metal-Level Authorization Grid has been updated to include an indicator for drugs

Fidelis Care is initiating a transition process for providers to identify members who are currently receiving group and family therapy services, and who will continue treatment beyond November 1, 2025, along with current frequency and duration. The below FAQ was created to address provider questions related to the updated authorization requirements, which are in effect for dates of service of November 1, 2025, and thereafter. Providers should submit their member rosters to qhcmbh@fideliscare.org using format outlined below, no later than October 31, 2025. This information will ensure a smooth transition for members engaged in treatment.   As a reminder: Effective November 1, 2025, the

NY State of Health has announced upcoming changes to the Essential Plan 5, effective July 1, 2026. To help current enrollees prepare, Fidelis Care members have started receiving official notifications from the state outlining these updates. To support you in addressing patient questions, Fidelis Care has compiled a list of frequently asked questions (FAQs) to guide your conversations and provide clarity. FAQs I have patients saying they received a letter about their Essential Plan coverage ending. What is going on? Essential Plan 5 members recently received a letter from NY State of Health notifying them that EP5 will end on July 1, 2026.

Fidelis Care will host three Provider Office Hours in November 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 – November 2025   Topic: Fidelis Care – Back to Basics When:  Thursday, November 13th – 9AM – 10AM EST Click here to register*   Topic: Fidelis Care and Wellcare - Quality Programs When:  Wednesday, November 19th – 10 AM – 11 AM EST

As we approach the final quarter of the year, we’re entering a critical phase of the Continuity of Care (CoC) program. Our shared goal remains clear: to ensure patients receive timely, high-quality care while closing the most impactful clinical gaps by December 31. To support you in this effort, we’ve refined the appointment agenda to focus on the most urgent and actionable opportunities with a particular emphasis on risk adjustment conditions. This streamlined approach is designed to: Prioritize the highest-value clinical care gaps for closure; Maximize your time during each patient encounter to focus on the more critical clinical and

Fidelis Care would like to inform providers that we are unable to accept calls from Artificial Intelligence (AI) entities or other automated systems to verify claim status, obtain remittance information, or respond to any other inquiries.  Fidelis Care representatives may only engage with a live person to verify PHI and ensure HIPAA compliance.   Providers are also encouraged to use the Fidelis Care Provider Portal to obtain needed information. For more information on the Provider Portal, please visit:  https://www.fideliscare.org/Provider/Provider-Access-Online-Resources   For additional questions, or if we can be of assistance in any way, please contact your Fidelis Care Provider Engagement Account Manager. To identify your