Section One
Introduction
INTRODUCTION TO FIDELIS CARE NEW YORK
As the New York State Catholic Health Plan, Inc., Fidelis Care was founded in 1993 on the belief
that all New Yorkers should have access to affordable, quality health insurance. Today, Fidelis
Care provides coverage for children and adults of all ages and at all stages of life, including
products available through the Metal-Level Products and Essential Plans. Fidelis Care continues
to offer the State-sponsored Child Health Plus and Medicaid programs, as well as Medicare
Advantage, Dual Advantage, Managed Long-Term Care (MLTC) programs - Fidelis Care at
Home, Medicaid Advantage Plus and is a Qualified Health Plan in the Marketplace.
Fidelis Care continually expands our programs and counties of operation. For a current listing of
programs, eligibility guidelines, and counties of operation, please visit our website at
www.fideliscare.org.
With a mission to serve the poor and medically underserved, Fidelis Care is one of the largest
government programs-based health insurance companies in the State and is committed to
working with providers to ensure members always receive the highest quality care and service.
Fidelis Care is a Prepaid Health Services Plan (PHSP).
Provider Manual Use and Interpretation
The Provider Manual is designed to help participating providers and their employees in
understanding Fidelis Care policies and procedures, and their role as network providers.
Information in this Manual is not intended to alter or modify the benefits to which the member is
entitled. If and when operational policies change, the Manual will be updated accordingly. The
most current version is always available on www.fideliscare.org.
Nothing contained in this Manual shall require or cause Fidelis Care to pay, reimburse, arrange,
or provide any service or participate in any activity that is not in accordance with the Ethical and
Religious Directives for Catholic Healthcare Services issued by the United States Catholic
Conference, as interpreted by the Bishop of the Diocese in which the provider renders services to
members. Providers may consult with Fidelis Care's Chief Medical Officer or his/her designee
with questions regarding which services are or are not included.
HOW FIDELIS CARE WORKS WITH PROVIDERS AND MEMBERS
Provider Relations Division
The Provider Relations Division is dedicated to fostering strong, long-term partnerships with all
contracted providers. This relationship begins with an initial orientation and is followed by
continuing education on policies, procedures, and issues that concern healthcare delivery within
the guidelines of Fidelis Care.
Quality Healthcare Management Division
The Quality Healthcare Management Division (QHCM) evaluates the quality and appropriateness
of healthcare services provided to Fidelis Care members. Case Managers can assist you with
authorizations and care coordination.
Member Services Division
The Member Services Division is available 24 hours a day, 7 days a week, to help members and
to respond to questions or concerns regarding their healthcare coverage. This includes
information regarding covered benefits, choosing or changing a primary care provider, orienting
members to our Plan, and member responsibilities. Member Services also solicits feedback from
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Introduction
members as to their satisfaction with services provided by Fidelis Care. It is always our goal to
address member concerns or complaints quickly and efficiently.
Claims Division
The Claims Division processes and pays claims for covered services provided in accordance with
the provider’s contract and Fidelis Care policies and procedures. Working with QHCM, the Claims
Division also collects encounter data for services.
HOW TO CONTACT FIDELIS CARE
The easiest and fastest way to access information regarding membership and eligibility, claims
information, and primary care physician assignment, is through the Fidelis Care’s Provider Portal,
Provider Access Online, on www.fideliscare.org.
Provider Access Online is easily accessible through the Provider section of our website.
The online registration process takes only a few minutes and providers typically have full access
to the Portal within 5-7 business days. Providers and their staff members can log in using a
secure user name and password 24 hours a day, 7 days a week.
For all other information, including contacting your Provider Relations Representative, the
Quality Care Management Incentive (QCMI) Program, or authorizations and care
coordination, please call:
1-888-FIDELIS (1-888-343-3547).
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REGIONAL OFFICES
As a Statewide health plan, Fidelis Care is committed to maintaining a local, regional presence
for our members and providers. Regional and satellite office locations are as follows:
Greater Metropolitan New York
Regional Office
95-25 Queens Boulevard
Rego Park, New York 11374
Fax: (718) 896-1920
400 Rella Blvd
Suite 116
Suffern, New York 10901
Suffern Satellite Office
Fax: (845) 368-0301
Northeastern Regional Office
8 Southwoods Blvd.
Albany, New York 12211
Fax: (518) 427-9584
25 Market Street
Suite 100
Poughkeepsie, New York 12601
Mid-Hudson Valley Satellite Office
Fax: (845) 483-1296
Western New York Regional Office
480 CrossPoint Parkway
Getzville, New York 14068
Fax: (716) 564-2374
1250 Pittsford Victor Road
Building 200 Suite 170
Pittsford, New York 14534
Greater Rochester/Finger Lakes
Satellite Office
Fax: (585) 383-8128
Central New York Regional Office
5010 Campuswood Dr.
East Syracuse, NY 13057
Fax: (315) 448-2236
HOW TO CONTACT FIDELIS CARE'S DENTAL, PHARMACY, AND VISION PROVIDERS
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Fidelis Care provides certain benefits through third-party benefits management organizations.
Providers should contact the benefits managers below to obtain authorizations and arrange
treatment as indicated.
Dental
DentaQuest (855) 343-4267
Pharmacy
Caremark (800) 345-5413
Vision
Davis Vision (800) 773-2847
OTHER USEFUL NUMBERS
New York State Child Abuse Reporting Hotline
(800) 342-3720
Early Intervention Program (EIP)
(800) 577-2229 (New York City)
Early Childhood Direction Center
(800) 462-7653 (New York State)
Vaccines for Children (VFC)
(800) 543-7468 or (800) KID-SHOTS
Women Infants and Children Program (WIC)
(800) 522-5006
NYS HIV Counseling, Testing and Other Services
Hotline
(800) 872-2777
NYS AIDS Institute
(800) 541-AIDS
Domestic Violence Hotline
(800) 942-6906 (English)
(800) 942-6908 (Spanish)
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