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Recent changes for the 2026 Health Insurance Marketplace may affect eligibility for members at health plans across the nation.  One important update is the way in which current and future Marketplace beneficiaries will apply for Advanced Premium Tax Credits (APTCs) in 2026 and beyond. That’s why Ambetter from Fidelis Care is sharing a quick reminder with our participating providers on the best way to confirm Member eligibility in the Availity Essentials platform and other secure portals.   Grace Periods for Members receiving an APTC Members enrolled in a Marketplace health plan are responsible for completing their premium payments each month. Members that do not

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

Access to quality care is essential to reducing health disparities and improving the quality and length of life for all New Yorkers.   The New York State Department of Health (NYSDOH) and CMS require that specific Access and Availability Standards be met by Primary Care Providers (PCPs), OB/GYNs, Specialists, and Behavioral Health Providers.   To ensure compliance, Fidelis Care conducts regular Access & Availability surveys to confirm providers meet these state-mandated standards for all Fidelis Care members.   The survey evaluates: Timeliness of appointment scheduling by appointment type Accuracy of provider directory listings Responsiveness of phone systems and office staff   Common issues leading to non-compliance include: Appointment

We want to inform you that we are currently experiencing high call volumes in our Provider Contact Center, which are impacting wait times. We understand the importance of timely support and appreciate your patience during this period.  Please consider using the Fidelis Care Provider Portal or Availity which offer convenient self-service options including but not limited to: claim status, authorization status and member eligibility. We will provide updates when available. Thank you for your understanding and continued partnership. If you have any questions, please contact your Fidelis Care Provider Engagement Account Manager. To find your designated representative, please click here.  Fidelis Care is proud to be

Special Supplemental Benefits for the Chronically Ill (SSBCI) can be offered to Medicare Advantage (MA) members who have one or more complex chronic conditions, are at high risk for hospitalization or adverse health outcomes and require intensive care coordination. SSBCI aims to improve overall health outcomes for the chronically ill population by addressing social needs beyond traditional medical care such as food, housing, transportation, and gaps in care. The program is designed to support individuals by offering additional services beyond standard Medicare coverage. Members must qualify for SSBCI benefits Members must meet all three criteria to qualify: The member must require intensive

As you know, Fidelis Care relies upon the receipt of membership information from the New York State Department of Health (SDOH) prior to issuing capitation payments. The date for receiving this information from the SDOH varies from month to month. In certain months, the availability of data may be delayed as much as one week. Nevertheless, Fidelis Care has historically made capitation payments as close to the first of each calendar month as possible.    Presented below is Fidelis Care’s 2026 capitation check and Electronic Funds Transfer (EFT) schedule. Please refer to this to determine the timing of your monthly payment.  Over