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Fidelis Care is pleased to announce a new Prior Authorization Requirement Lookup Tool to help improve the experience of providers. The new, web-based tools will help providers determine which procedure codes require pre-authorization for Medicaid (including Child Health Plus and HARP products), Medicare, Essential Plans, and Qualified Health Plans (Ambetter from Fidelis Care).

Streamlined Access for Providers: Access the lookup tool on fideliscare.org:

• Navigate to Providers
• Under Provider Resources, find Authorization Grids
• Click on the Medicaid, Child Health Plus, HealthierLife (HARP), Medicare, Essential Plan or Qualified Health Plan drop-down menu
• Select Authorization Lookup Tool at the top of the menu

Benefits of the New Tool:

• Faster Determinations: Providers can more quickly determine whether or not a code needs prior authorization.
• Real-Time Procedure Code Updates: Experience quicker updates to both new and existing procedure codes, enabling more accurate and timely information.

Reference Guide:  For further information and instructions on using the tool, providers can review the Authorization Lookup Tool Reference Guide.

Authorization Grids: If a code is not found while using the tool, providers should refer to the authorization grids located here.  If still uncertain whether prior authorization is required, providers should submit a request for authorization through the Provider Portal. 

We are excited about the enhanced capabilities this tool brings to our provider community, and we appreciate your continued partnership.

If you have any questions, please contact your Fidelis Care Provider Relations Specialist. To find your designated representative, please visit Contact Your Designated Provider Relations Specialist.

DISCLAIMER:  While every effort is made to provide the most current information on the Pre-Authorization Tool, it is important to note that this does not guarantee payment or confirm patient eligibility. For specific details, please refer to the current authorization grids and provider manual. If you are uncertain whether prior authorization is needed, please submit a request for authorization through the Provider Portal.