Special Announcements
Please notify any staff involved with Quality Management and/or the Fidelis Care QCMI Program that the 2014 Q1 Provider Report Cards have been posted to accounts on Provider Access Online as of February 7, 2014.
As part of a Medicaid Redesign Team initiative, under the New York State Department of Health, the non-emergency medical transportation benefit (NEMT) for Medicaid members is phasing out of the managed care benefit package in Monroe County effective January 1, 2014.
Please notify any staff involved with Quality Management and/or the Fidelis Care QCMI Program that the 2013 Q4 Provider Report Cards have been posted to accounts on Provider Access Online as of October 31st. New for Q4: New York State has retired the Use of Appropriate Medications for People with Asthma 3+ Controller Medications for measurement year 2013. Fidelis Care has replaced that measure with the Medication Management for People with Asthma Measure.
Fidelis Care has updated its formulary effective 10/1/13. Please see attached summary for details of the changes
The Medicare Risk Adjustment 2013 Medical Record Request Letter is now available. Please notify any of your staff involved with Quality Management and/or the Fidelis Care QCMI program that the Medicare Risk Adjustment 2013 medical record request letter and member lists, dated September 3, 2013
Fidelis Care has updated the Authorization Grids for Medicare, Medicaid, Family Health Plus, and Child Health Plus programs. These changes are effective September 1, 2013 and include Adult Day Health Care and AIDS Adult Day Health Care for the Medicaid line of business.
Providers who participate in the Quality Care Management Incentive (QCMI) are requested to log into Provider Access On-Line and go to file download to access information that could impact your 2012 Quality Care Management Incentive for two measures. Please click on the heading of this announcement to access Provider Access OnLine.
As part of the federal Patient Protection and Affordable Care Act (ACA), a Health Benefit Exchange (HBX) will operate in every state beginning on January 1, 2014. New York has emerged as a leader in this initiative, and is one of 18 states planning to implement a State-based Exchange this year.
Providers who have access to Provider Access Online, Fidelis Care's Provider Portal, can continue to obtain the RA online. For providers who have not signed up for Portal access, Fidelis Care incorporates a 16-digit passcode on the Remittance Advice Notification. The passcode provides direct access to the RA through the Portal. The passcode is only valid for 45 days for that specific check. Fidelis Care encourages all providers who do not have Portal access to complete a simple and easy registration process. Providers can contact the Provider Call Center at 1-888-FIDELIS (343-3547) to obtain access. Provider Access Online gives providers the ability to electronically review RA, claims, patient eligibility, roster data, Quality Care Management Incentive program information, provider newsletters, and other communication.
Fidelis Care is pleased to announce that the 2013 QCMI Brochure is now available on Provider Access Online. The performance thresholds will be based on 2014 QARR data (service year 2013) reported to New York State by Medicaid Managed Care Plans and usually made public in November 2014. The Medicare thresholds will be based on national 2014 HEDIS (service year 2013), expected to be made public in early 2015.
The QARR/HEDIS 2013 Medical Record Request Letter is now available. Please notify any of your staff involved with Quality Management and/or the Fidelis Care QCMI program that the QARR/ HEDIS 2013 medical record request letter and member lists, dated February 13th, have been posted on to Provider Access Online as of February 14, 2013 .