Out-of-Network Providers Fee Schedule Update
January 30, 2025
Fidelis Care New Jersey is dedicated to collaborating with providers to help our members achieve the best possible health outcomes. We effectively support both providers and members via emphasis on strong relationship-building with qualified, high-performing providers. Through enhanced provider collaboration, we prioritize our in-network partnerships with the aim of improving member compliance, quality, and overall performance outcomes.
In alignment with these goals, beginning January 1, 2025, Fidelis Care New Jersey Medicaid/NJ FamilyCare Plan providers who are not part of the Fidelis Care New Jersey Medicaid/NJ FamilyCare network will receive reimbursement based on the payor's fee schedule.
The following services are excluded:
- Adult Medical Day Care
- Assisted Living
- Behavioral Health
- Community Residential Services for Traumatic Brain Injury (TBI)
- Custodial Nursing Facility
- Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Private Duty Nursing
- Emergency Department (ED) Triage
- Emergency Room
- Emergency Transportation for dually-eligible members
- Hospice supplied in a nursing facility
- Labs
- Managed Long-Term Services and Supports
(MLTSS) Private Duty Nursing - Pediatric Medical Day Care
- Personal Care Assistant (PCA); agency-based
- School Based Services
Please remember that providers are not allowed to bill Fidelis Care New Jersey Medicaid/NJ Family Care or WellCare Dual Liberty plan members for the difference between the billed amount and the amount paid by Fidelis Care New Jersey. Additionally, Fidelis Care New Jersey expects current in-network providers to refer members to participating providers whenever possible, as outlined in their participating provider agreement.
For additional resources or information on this change, please access the Fidelis Care New Jersey provider portal at provider.fideliscarenj.com or call Fidelis Care New Jersey Provider Services at 1-888-453-2534.