The Fidelis Care Blog

The following sections of the Fidelis Care authorization grids have been updated effective June 1, 2022.

The Medicaid Plan grid has been updated as follows:

           Children’s Home and Community Based Services

7. Respite Services (Planned Respite and Crisis Respite) EFFECTIVE 6/1/22, notification is no longer needed for Respite Services.

            Pharmacy:

                            The following codes have been added to the Medicaid authorization grid and requires prior authorization:

                            J2278   ziconotide (Prialt)~

                            J8670   rolapitant (Varubi)

                   ~ authorization is required for NYM/HARP members; it is not required for CHP members

The Medicaid, Essential Plan, Medicare, & Metal Level Plan grids have been updated as follows:

              Durable Medical Equipment/Supplies:

                        4. Supplies requiring authorization:

b. Electric breast pumps (codes E0602 and E0603) have been removed and no longer require authorization.

Visit:  Authorization Grids

COVID-19 UPDATE: Please refer to this link:  Important Updates Regarding Coronavirus COVID-19, for authorization and coding guidelines related to the COVID-19 Pandemic.

The following sections of the Fidelis Care authorization grids have been updated effective June 1, 2022.

The Medicaid Plan grid has been updated as follows:

           Children’s Home and Community Based Services

7. Respite Services (Planned Respite and Crisis Respite) EFFECTIVE 6/1/22, notification is no longer needed for Respite Services.

            Pharmacy:

                            The following codes have been added to the Medicaid authorization grid and requires prior authorization:

                            J2278   ziconotide (Prialt)~

                            J8670   rolapitant (Varubi)

                   ~ authorization is required for NYM/HARP members; it is not required for CHP members

The Medicaid, Essential Plan, Medicare, & Metal Level Plan grids have been updated as follows:

              Durable Medical Equipment/Supplies:

                        4. Supplies requiring authorization:

b. Electric breast pumps (codes E0602 and E0603) have been removed and no longer require authorization.

Visit:  Authorization Grids

COVID-19 UPDATE: Please refer to this link:  Important Updates Regarding Coronavirus COVID-19, for authorization and coding guidelines related to the COVID-19 Pandemic.