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The following sections of the Fidelis Care authorization grids have been updated effective January 1, 2026.             The following has been added to the Medicaid Authorization Grid and requires prior authorization: IV.       Behavioral Health - Outpatient Services                R. Family Psychotherapy Covered; Authorization Required for CPT Codes 90847 Starting January 1, 2026, Fidelis Care will require notification and concurrent review for Group Psychoeducation (Mental Health) services for any requests beyond the initial 30 visits per calendar year.  Note: Substance Use Disorder (SUD) group/family therapy do not require authorization. Requests for members can be made by email qhcmbh@fideliscare.org, fax (833-561-0098)

Fidelis Care will host two Provider Office Hours in December 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 – December 2025   Topic: Fidelis Care – Back to Basics When:  Thursday, December 11th – 12 PM – 1 PM EST Click here to register*   Topic: Fidelis Care and Wellcare - Quality Programs When:  Wednesday, December 17th – 10 AM – 11

Access to quality care is important to eliminate health disparities and increase the quality and years of healthy life for all New Yorkers. The NYSDOH requires that certain Access and Availability Standards be met by PCPs, OB/GYNs, specialists, and behavioral health providers where applicable. Click here to view the full list of standards, including situations and timeframes.   For additional questions, or if we can be of assistance in any way, please contact your Fidelis Care Provider Engagement Account Manager. To find your designated representative, please click here. 

Fidelis Care has been made aware of an issue affecting providers who are unable to obtain authorizations through the Evolent/RadMD portal due to their NPI or TIN not appearing in the system. The issue has been identified and escalated as a priority for resolution. What to Do: If you are unable to obtain authorizations through the Evolent/RadMD website, please contact the Evolent Call Center: Fidelis Care (NY) – Medicaid or Exchange: 1-800-424-4952 Fidelis Care (NY) – Medicare: 1-800-424-5390   We anticipate this issue will be resolved by early next week. Once it is addressed, we will share an update. If you have any additional questions, please

Fidelis Care would like to inform our providers of plan changes that will be effective January 1, 2026.    Wellcare By Fidelis Care Wellcare Fidelis Dual Plus (HMO D-SNP) – Plan 003 Effective January 1, 2026, the plan name will change from Wellcare Fidelis Dual Plus (HMO D-SNP) to Wellcare Fidelis Dual Align (HMO D-SNP). Wellcare Fidelis Dual Access (HMO D-SNP)

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