Effective January 1, 2012, Medicaid Managed Care and Family Health Plus will have a limited benefit of 20 visits for each therapy during a calendar year.

Please notify any staff involved with Quality Management and/or the Fidelis Care QCMI program that the 2012 Q1 Provider Report Cards have been posted to accounts on Provider Access Online as of January 26, 2012.

This program provides incentive payments to eligible professionals (EPs) and eligible hospitals (EHs) as providers adopt, implement, or upgrade and subsequently demonstrate meaningful use of certified EHR technology.

The New York State Department of Health has announced that under the Medicaid Redesign Team, the non-emergency transportation benefit (NEMT) for Medicaid members will be phased out of the managed care benefit package by region beginning in 2012.

Please notify any staff involved with Quality Management and/or the Fidelis Care QCMI program that the Q4 Provider Report Cards have been posted to accounts on Provider Access Online as of November 1, 2011.

Fidelis Care has updated the thresholds for the 2011 Medicaid QCMI program, using the just released 2010 performance data for Medicaid Managed Care Plans in New York State. The thresholds for the Medicare program have also been updated based on the most current Medicare data available. The New York State Department of Health has made some minor changes to the codes for some of the measures. Those changes have been incorporated into the tables. These changes are reflected on pages 6, 7, 9 and 11 of the 2011 QCMI Brochure.

Based on your feedback, Fidelis Care has streamlined the process for requesting certain covered services.

Recently, letters were sent to members and providers informing them about medications that are not on the Fidelis Care Preferred Drug List, and that pre-approval of these medications would be required after October 1, 2011.

Changes in medication coverage letter from Chief Medical Officer Sanjiv Shah, MD.

The pharmacy benefits for Fidelis Medicaid and Family Health Plus (FHP) members will be carved back into the benefit package provided by Fidelis Care effective October 1, 2011.

In March 2011, Fidelis Care introduced Provider Access Online —a single point of electronic access to key business information and documents. Fidelis Care is pleased to announce the following enhancements to Provider Access Online.

The Medicaid Redesign Team (MRT) was established to contain costs, create efficiencies, and improve the quality of care. Based on the recommendations of the MRT, several changes have been made to the Medicaid Managed Care program.

As providers, we are all keenly aware that cigarette smoking has been identified as the most important source of preventable illness and premature death worldwide.

Please ensure that hospital outpatient radiology procedures are billed with the appropriate technical component modifier.

Authorization Grid Update

Fluoride varnish treatments from birth until 7 years of age in children with moderate to high risk for caries are covered benefits under the Medicaid and Child Health Plus Program.

Electronic options for submitting claims to Fidelis.