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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

The Clinical Laboratory Improvement Amendments of 1988 is federal legislation with the objective of ensuring quality laboratory testing. It applies to any facility or individual Provider that performs laboratory services and wants to receive payments under Medicare and Medicaid programs. Fidelis Care will continue to uphold the Federal and State guidelines to ensure laboratory claims submitted by providers meet these requirements: A valid CLIA certificate for the type of tests performed at each location An active CLIA certificate Exceptions are based on both NYS and CMS Regulations          Providers should submit their CLIA number on the claim as follows: Electronic Claim: Loop

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