Stay informed with the Spring 2026 Fidelis Care Provider Bulletin, featuring seasonal health tips, preventive care guidance, plan updates, and helpful resources to help our members.
Be Part of the Discussion: Help Us Improve Your Experience
You’re invited to join the new Provider Advisory Community, an online space where you can share feedback on administrative and clinical challenges, digital tools, opportunities for improvement, and the overall experience working with Fidelis Care. Participation includes taking surveys and quick polls and engaging in community-based discussion. All activities are designed to help us improve our programs and processes with your feedback in mind. If you’re interested in participating, please contact your Provider Engagement Account Manager for more information.
2026 Provider Satisfaction Survey Our annual provider satisfaction survey launched April 2026. We hope you took a few moments to share your feedback. If you haven't already completed the survey, we encourage you to do so before the June 26, 2026 deadline.
This survey serves as the foundation for key improvement initiatives that we undertake each year, and your feedback is critical to making sure we address the issues that are important to you. We look forward to learning about how we can continue to improve your experience in doing business with us. Please keep an eye out for insights from your feedback in the next Provider Bulletin. Essential Plan 200–250 Update for Your Patients Fidelis Care providers should be aware that patients enrolled in Essential Plan 200–250 may have received communications from NY State of Health and Fidelis Care regarding upcoming changes to their coverage. Essential Plan 200–250 is expected to end on June 30, 2026. Providers are encouraged to remind patients to review all materials from NY State of Health and to take any necessary steps to stay insured. For additional support, patients can contact their Fidelis Care representative to explore coverage options. Afected patients should enroll in a new plan by June 15 to have coverage on July 1.
Find Your Provider Engagement Account Manager!
Learn About Fidelis Care Provider Ofce Hours Sessions Information on Provider Ofce Hours sessions can be found in the Provider Portal.
Update Your Practice Information Visit fideliscare.org/provider -forms to access the form.
Visit the Contact Your Designated Provider Relations Specialist page on fideliscare.org.
FIDELIS CARE PROVIDER BULLETIN • SUMMER 2026
Improving Member Satisfaction and Care Quality Member experience is shaped by the everyday moments in your practice, from how quickly patients can get an appointment to how clearly next steps are explained. The tips below highlight simple, practical actions that can help improve satisfaction and • Consider open scheduling • If you ofer telehealth services, let your patients know how to schedule a visit Coordination • Designate ofce staf to help patients manage their care and get records • Use plain language when speaking to patients • Encourage patients to ask questions • Explain test results and review patients’ prescriptions Health Education • Speak with patients about key health topics, such as getting a fu shot and quitting smoking • Provide takeaway educational resources • Remind patients many preventive services have no cost-sharing support better care quality. Getting Needed Care
Support Your Patients in Managing Diabetes The Centers for Disease Control and Prevention (CDC) recommends providers consult the latest Clinical Guidance for Diabetes to ensure patients receive timely, equitable, and high-quality care. This document ofers the latest guidelines for screenings and management for diabetes, cardiovascular disease, and chronic kidney
disease. You can make a diference in diabetes management, primarily by confrming a diagnosis in at-risk patients, acting rapidly to adopt a treatment plan, and supporting patients for ongoing follow-up. A diabetes management plan might include: • Eye exams (EED)/A1c Control (HBD)/Medication Adherence • Participation in a CDC-recognized diabetes prevention lifestyle change • Loss of small amounts of weight (5 to 7 percent of total body weight) • Adoption of healthy food choices • Promotion of physical activity
Spring 2026 Fidelis Care Provider Bulletin pg. 2
Medication Adherence Season: Make Every Fill Count (SPC-E & SUPD Focus) As we move deeper into the year, medication adherence
performance becomes harder to “catch up” on later. The good news: Small, consistent workfow habits — plus accurate billing and documentation — can improve your performance and support better outcomes for your patients. Why this matters right now Medication adherence measures build across the measurement year. Once adherence “days” are lost early in the year, they can’t be recovered later. Early identifcation of refll risk is key.
Quick facts: Measurement Year (MY) 2026 runs January 1, 2026 through December 31, 2026. Medication adherence is measured over time — early engagement matters.
What Fidelis Care is measuring SPC-E (Statin Therapy for Patients With Cardiovascular Disease) Two results are reported: • Received Statin Therapy: At least one high- or moderate-intensity statin dispensed during the measurement period. • Statin Adherence: Remained on therapy for ≥80% of the treatment period. Provider-friendly focus: Review the medication list every visit, discuss side efects, and encourage auto-refll when appropriate. SUPD (Statin Use in Persons With Diabetes) This measure looks for a single statin fll for persons with diabetes ages 40–75 during the measurement period. This measure is often targeted later in the year, but success is easier when the work starts early. Billing and workfow tips that protect adherence rates • Make sure pharmacy events are visible in the beneft data. For adherence measures, flls should run through the patient’s health insurance; cash payments, samples, or out-of-network pharmacy flls do not count. • Avoid samples when adherence is being measured. Samples can negatively impact adherence measurement and/or the “received therapy” rate. • Consider extended days’ supply and refll supports when clinically appropriate (auto-refll, mail order, and extended supply). • Use supportive, non-judgmental adherence check-ins to identify barriers (cost, side efects, understanding) and defne a practice process for follow-up with persons at risk.
Spring 2026 Fidelis Care Provider Bulletin pg. 3
Don’t miss exclusions: Capture them cleanly Appropriate exclusions help ensure patients are counted accurately. When an exclusion applies, ensure it is clearly documented in the medical record and refected in the claim/encounter pathway so measurement aligns with clinical reality. Common ICD-10-CM examples for exclusions (not all-inclusive; subject to change): Tip: Use diagnosis codes on the claim/encounter when an exclusion applies; some exclusions may also be captured via paid pharmacy claims where applicable. Measure Exclusion Common ICD-10-CM code examples
SUPD
Rhabdomyolysis/Myopathy/Myositis
G72.0, G72.89, G72.9, M60.80, M60.819, M60.829, M60.839, M60.849, M60.859, M60.869, M60.879, M60.9, M62.82 K70.30, K70.31, K71.7, K74.3, K74.4, K74.5, K74.60, K74.69
SUPD
Cirrhosis
SUPD SUPD SUPD
Pre-diabetes
R73.03, R73.09
Polycystic ovary syndrome (PCOS) End-stage renal disease (ESRD)
E28.2
I12.0, I13.11, I13.2, N18.5, N18.6, N19, Z91.15, Z99.2
SPC-E
Myalgia/Myopathy/Myositis/ Rhabdomyolysis
M79.1, M79.10, M79.12, M79.18, G72.0, G72.2, G72.9, M60.80, M60.811, M60.812, M60.819, M60.821, M60.822, M60.829, M60.831, M60.832, M60.839, M60.841, M60.842, M60.849, M60.851, M60.852, M60.859, M60.861, M60.862, M60.869, M60.871, M60.872, M60.879, M60.88, M60.89, M60.9, M62.82 K70.30, K70.31, K71.7, K74.3, K74.4, K74.5, K74.60, K74.69, P78.81
SPC-E
Cirrhosis
SPC-E SPC-E
ESRD (examples)
N18.5, N18.6, Z99.2
Palliative care (encounter) Z51.5 Top 5 Reminders — SPC-E / SUPD Adherence Season
1. Start early. Lost adherence days can’t be “made up” later. 2. Make sure flls count: Pharmacy claims should run through the patient’s health plan insurance; cash pay, samples, and out-of-network flls don’t count for adherence measures. 3. Avoid samples for statins when adherence is being measured. Samples can negatively impact measurement. 4. Use refll supports (when appropriate): Auto-refll, mail order, and extended days’ supply can help reduce gaps. 5. Document exclusions when they apply and code them appropriately (see common ICD-10 examples above) so persons are counted appropriately. Spring 2026 Fidelis Care Provider Bulletin pg. 4
Supporting Your Patients Through New York’s Social Care Networks • As part of the CMS-approved $7.5 billion New York 1115 Medicaid Waiver Amendment, Social Care Networks (SCNs) are now active across all regions of the state, connecting Medicaid members with critical services that address health-related social needs. • Services are funded through March 31, 2027, and there is a statewide goal of screening 100% of eligible Medicaid members by the end of the demonstration period. • Nine regional SCN Lead Entities coordinate a contracted network of community-based organizations and social care service providers to screen members and deliver services — including food assistance, housing support, transportation, education, and employment resources. • Research continues to show that addressing these social determinants leads to improved health outcomes and reduced cost of care, making this program a vital complement to the clinical care you provide. • You can inform patients about the availability of SCN services, share contact information for the SCN in their residential county, and — when requested — provide a Provider Attestation to support a patient’s eligibility for enhanced services. • Providers also have the option to contract directly with an SCN Lead Entity to receive reimbursement for screening and service navigation. Whether or not you choose to formally join an SCN, sharing screenings is strongly encouraged by the Department of Health to support program goals. For more information — including a county look-up tool to identify your patients’ regional SCN — visit fdeliscare.org/SCN or contact your regional SCN Lead Entity directly. Access & Availability Standards: What to Know New York State Department of Health access and availability standards help ensure members receive timely care across Primary Care, Behavioral Health, OB/GYN, and Oncology. Common compliance challenges, such as inaccurate provider information, appointment delays due to paperwork, or limited after hours access, can create barriers to care. Providers and ofce staf play a critical role in improving access and supporting a better member experience. Why Your Compliance Matters Compliance with access and availability standards is essential for delivering timely, quality care. Together, we ensure members get the right care, at the right time, in the right setting. Quick Solutions & Reminders • Always verify provider status and plan participation before telling a patient “no.” If unsure, ofer to call them back with accurate info. • Don’t let paperwork or referrals delay care. Schedule the appointment frst, then guide the patient through what’s needed before the visit. • Patients with a scheduled appointment should not be kept waiting more than one hour. • Patient calls must be returned within 30 minutes. • Providers may meet the appointment wait time standards through telehealth services, unless the patient specifcally requests an in-person appointment.
Spring 2026 Fidelis Care Provider Bulletin
pg. 5
Important Reminders About HIV Prevention and Testing To help stop the spread of human immunodefciency virus (HIV), providers are encouraged to speak to patients about prevention measures. The CDC recommends that everyone between the ages of 13 and 64 get tested for HIV at least once as part of routine healthcare. People with higher risk factors — including those who shared needles, had partners with HIV, or had tuberculosis — should get tested more often. More HIV testing information is available from the CDC at https://cdc.gov/hiv/testing/?CDC_
AAref_Val=https://cdc.gov/hiv/basics/testing.html. Preventing Perinatal HIV Transmission
Perinatal HIV transmission can happen at any time during pregnancy, childbirth, or breastfeeding. To help prevent transmission, providers should inform pregnant, HIV-positive individuals that they can efectively reduce the risk of transmission by: • Visiting their healthcare provider regularly • Taking their antiretroviral therapy (ART) medications as prescribed • Asking their provider if cesarean delivery is needed • Giving HIV medications to their child for 4-6 weeks after birth, as prescribed • Not breastfeeding or pre-chewing their baby’s food For more information, visit The New York State Department of Health’s (SDOH) Provider Reporting and Partner Services at health.ny.gov/diseases/aids/providers/regulations/partner_services. For updated reporting requirements, timelines, reporting methods, including instructions for accessing the HIV/AIDS Provider Portal, please visit NYSDOH 2023 Changes to Provider Reporting of Human Immunodefciency Virus (HIV) in New York State at hivguidelines.org/wp-content/uploads/2023/11/ PublicHealthLawCommunication_2023.pdf. How to Find Your Provider Relations and Quality Improvement Specialists The Provider Relations Department at Fidelis Care is committed to building strong and lasting relationships with our providers. If you have a need or concern, please contact your designated Provider Relations or Quality Improvement Specialists. You can search for your Provider Relations Specialist by visiting the Contact Your Designated Provider Relations Specialist page. You can also fnd the contact information for your Quality Improvement Specialist on the Quality Information page. If you have an immediate need or are a non-participating provider, please contact our Call Center at 1-888-FIDELIS (1-888-343-3547), (TTY: 711) or email Contact_PR@fdeliscare.org. This email address is intended only for providers and their staf.
Spring 2026 Fidelis Care Provider Bulletin pg. 6
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