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Authorizations

Fidelis Care requires prior authorization for some services. Our Utilization Management Department evaluates authorization requests to determine medical necessity, appropriateness, and delivery of care. Below you will find information and links to internal Fidelis Care prior authorization submission resources as well as links to external vendor authorization programs.



Provider-Authorizations_02

Fidelis Care Authorization Grids and Look Up Tools

View authorization information available for Medicare, Medicaid, Child Health Plus, Essential Plan, and Qualified Health Plans (Metal-Level Products).

Medicaid, Child Health Plus, and HealthierLife (HARP)

Medicaid Authorization Look Up Tool


2026

Authorization Grid Detail, Effective April 1, 2026 (PDF)

Authorization Grid Detail, Effective March 1, 2026 (PDF)

Authorization Grid Detail, Effective February 1, 2026 (PDF)

Authorization Grid Detail, Effective January 1, 2026 (PDF)


2025

Authorization Grid Detail, Effective December 1, 2025 (PDF)

Authorization Grid Detail, Effective November 1, 2025 (PDF)

Authorization Grid Detail, Effective October 1, 2025 (PDF)

Authorization Grid Detail, Effective September 1, 2025 (PDF)

Authorization Grid Detail, Effective August 1, 2025 (PDF)

Authorization Grid Detail, Effective July 1, 2025 (PDF)

Authorization Grid Detail, Effective June 1, 2025 (PDF)

Authorization Grid Detail, Effective May 1, 2025 (PDF)

Authorization Grid Detail, Effective April 1, 2025 (PDF)

Authorization Grid Detail, Effective March 1, 2025 (PDF)

Authorization Grid Detail, Effective February 1, 2025 (PDF)

Authorization Grid Detail, Effective January 1, 2025 (PDF)


2024

Authorization Grid Detail, Effective December 1, 2024 (PDF)

Authorization Grid Detail, Effective November 1, 2024 (PDF)

Authorization Grid Detail, Effective October 1, 2024 (PDF)

Authorization Grid Detail, Effective August 1, 2024 (PDF)

Authorization Grid Detail, Effective July 1, 2024 (PDF)

Authorization Grid Detail, Effective June 1, 2024 (PDF)

Authorization Grid Detail, Effective May 1, 2024 (PDF)

Authorization Grid Detail, Effective April 1, 2024 (PDF)

Authorization Grid Detail, Effective March 1, 2024 (PDF)

Authorization Grid Detail, Effective February 1, 2024 (PDF)

Authorization Grid Detail, Effective January 1, 2024 (PDF)


2023  

Authorization Grid Detail, Effective December 1, 2023 (PDF)

Authorization Grid Detail, Effective November 1, 2023 (PDF)

Authorization Grid Detail, Effective October 1, 2023 (PDF)

Authorization Grid Detail, Effective September 1, 2023 (PDF)

Authorization Grid Detail, Effective August 1, 2023 (PDF)

Authorization Grid Detail, Effective July 1, 2023 (PDF)

Authorization Grid Detail, Effective June 1, 2023 (PDF)

Authorization Grid Detail, Effective May 1, 2023 (PDF)

Authorization Grid Detail, Effective April 1, 2023 (PDF)

Authorization Grid Detail, Effective March 1, 2023 (PDF)

Authorization Grid Detail, Effective February 1, 2023 (PDF)

Authorization Grid Detail, Effective January 1, 2023 (PDF)

Wellcare By Fidelis Care (Medicare)

Medicare Authorization Look Up Tool 


2026

Authorization Grid Detail, Effective April 1, 2026 (PDF)

Authorization Grid Detail, Effective March 1, 2026 (PDF)

Authorization Grid Detail, Effective February 1, 2026 (PDF)

Authorization Grid Detail, Effective January 1, 2026 (PDF)


2025

Authorization Grid Detail, Effective December 1, 2025 (PDF)

Authorization Grid Detail, Effective November 1, 2025 (PDF)

Authorization Grid Detail, Effective October 1, 2025 (PDF)

Authorization Grid Detail, Effective September 1, 2025 (PDF)

Authorization Grid Detail, Effective August 1, 2025 (PDF)

Authorization Grid Detail, Effective July 1, 2025 (PDF)

Authorization Grid Detail, Effective June 1, 2025 (PDF)

Authorization Grid Detail, Effective May 1, 2025 (PDF)

Authorization Grid Detail, Effective April 1, 2025 (PDF)

Authorization Grid Detail, Effective March 1, 2025 (PDF)

Authorization Grid Detail, Effective February 1, 2025 (PDF)

Authorization Grid Detail, Effective January 1, 2025 (PDF)


2024

Authorization Grid Detail, Effective December 1, 2024 (PDF)

Authorization Grid Detail, Effective November 1, 2024 (PDF)

Authorization Grid Detail, Effective October 1, 2024 (PDF)

Authorization Grid Detail, Effective August 1, 2024 (PDF)

Authorization Grid Detail, Effective July 1, 2024 (PDF)

Authorization Grid Detail, Effective June 1, 2024 (PDF)

Authorization Grid Detail, Effective May 1, 2024 (PDF)

Authorization Grid Detail, Effective April 1, 2024 (PDF)

Authorization Grid Detail, Effective March 1, 2024 (PDF)

Authorization Grid Detail, Effective February 1, 2024 (PDF)

Authorization Grid Detail, Effective January 1, 2024 (PDF)


2023

Authorization Grid Detail, Effective December 1, 2023 (PDF)

Authorization Grid Detail, Effective November 1, 2023 (PDF)

Authorization Grid Detail, Effective October 1, 2023 (PDF)

Authorization Grid Detail, Effective September 1, 2023 (PDF)

Authorization Grid Detail, Effective August 1, 2023 (PDF)

Authorization Grid Detail, Effective July 1, 2023 (PDF)

Authorization Grid Detail, Effective June 1, 2023 (PDF)

Authorization Grid Detail, Effective May 1, 2023 (PDF)

Authorization Grid Detail, Effective April 1, 2023 (PDF)

Authorization Grid Detail, Effective March 1, 2023 (PDF)

Authorization Grid Detail, Effective February 1, 2023 (PDF)

Authorization Grid Detail, Effective January 1, 2023 (PDF)

Ambetter from Fidelis Care (Qualified Health Plans)

Qualified Health Plans (Metal-Level Products) Authorization Look Up Tool


2026

Authorization Grid Detail, Effective April 1, 2026 (PDF)

Authorization Grid Detail, Effective March 1, 2026 (PDF)

Authorization Grid Detail, Effective February 1, 2026 (PDF)

Authorization Grid Detail, Effective January 1, 2026 (PDF)


2025

Authorization Grid Detail, Effective December 1, 2025 (PDF)

Authorization Grid Detail, Effective November 1, 2025 (PDF)

Authorization Grid Detail, Effective October 1, 2025 (PDF)

Authorization Grid Detail, Effective September 1, 2025 (PDF)

Authorization Grid Detail, Effective August 1, 2025 (PDF)

Authorization Grid Detail, Effective July 1, 2025 (PDF)

Authorization Grid Detail, Effective June 1, 2025 (PDF)

Authorization Grid Detail, Effective May 1, 2025 (PDF)

Authorization Grid Detail, Effective April 1, 2025 (PDF)

Authorization Grid Detail, Effective March 1, 2025 (PDF)

Authorization Grid Detail, Effective February 1, 2025 (PDF)

Authorization Grid Detail, Effective January 1, 2025 (PDF)


2024

Authorization Grid Detail, Effective December 1, 2024 (PDF)

Authorization Grid Detail, Effective November 1, 2024 (PDF)

Authorization Grid Detail, Effective October 1, 2024 (PDF)

Authorization Grid Detail, Effective August 1, 2024 (PDF)

Authorization Grid Detail, Effective July 1, 2024 (PDF)

Authorization Grid Detail, Effective June 1, 2024 (PDF)

Authorization Grid Detail, Effective May 1, 2024 (PDF)

Authorization Grid Detail, Effective April 1, 2024 (PDF)

Authorization Grid Detail, Effective March 1, 2024 (PDF)

Authorization Grid Detail, Effective February 1, 2024 (PDF)

Authorization Grid Detail, Effective January  1, 2024 (PDF)


2023

Authorization Grid Detail, Effective December 1, 2023 (PDF)

Authorization Grid Detail, Effective November 1, 2023 (PDF)

Authorization Grid Detail, Effective October 1, 2023 (PDF)

Authorization Grid Detail, Effective September 1, 2023 (PDF)

Authorization Grid Detail, Effective August 1, 2023 (PDF)

Authorization Grid Detail, Effective July 1, 2023 (PDF)

Authorization Grid Detail, Effective June 1, 2023 (PDF)

Authorization Grid Detail, Effective May 1, 2023 (PDF)

Authorization Grid Detail, Effective April 1, 2023 (PDF)

Authorization Grid Detail, Effective February 1, 2023 (PDF)

Authorization Grid Detail, Effective January 1, 2023 (PDF)

Essential Plan

Essential Plan Authorization Look Up Tool


2026

Authorization Grid Detail, Effective April 1, 2026 (PDF)

Authorization Grid Detail, Effective March 1, 2026 (PDF)

Authorization Grid Detail, Effective February 1, 2026 (PDF)

Authorization Grid Detail, Effective January 1, 2026 (PDF)


2025

Authorization Grid Detail, Effective December 1, 2025 (PDF)

Authorization Grid Detail, Effective November 1, 2025 (PDF)

Authorization Grid Detail, Effective October 1, 2025 (PDF)

Authorization Grid Detail, Effective September 1, 2025 (PDF)

Authorization Grid Detail, Effective August 1, 2025 (PDF)

Authorization Grid Detail, Effective July 1, 2025 (PDF)

Authorization Grid Detail, Effective June 1, 2025 (PDF)

Authorization Grid Detail, Effective May 1, 2025 (PDF)

Authorization Grid Detail, Effective April 1, 2025 (PDF)

Authorization Grid Detail, Effective March 1, 2025 (PDF)

Authorization Grid Detail, Effective February 1, 2025 (PDF)

Authorization Grid Detail, Effective January 1, 2025 (PDF)


2024

Authorization Grid Detail, Effective December 1, 2024 (PDF)

Authorization Grid Detail, Effective November 1, 2024 (PDF)

Authorization Grid Detail, Effective October 1, 2024 (PDF)

Authorization Grid Detail, Effective August 1, 2024 (PDF)

Authorization Grid Detail, Effective July 1, 2024 (PDF)

Authorization Grid Detail, Effective June 1, 2024 (PDF)

Authorization Grid Detail, Effective May 1, 2024 (PDF)

Authorization Grid Detail, Effective April 1, 2024 (PDF)

Authorization Grid Detail, Effective March 1, 2024 (PDF)

Authorization Grid Detail, Effective February 1, 2024 (PDF)

Authorization Grid Detail, Effective January  1, 2024 (PDF)


2023

Authorization Grid Detail, Effective December 1, 2023 (PDF)

Authorization Grid Detail, Effective November 1, 2023 (PDF)

Authorization Grid Detail, Effective October 1, 2023 (PDF)

Authorization Grid Detail, Effective September 1, 2023 (PDF)

Authorization Grid Detail, Effective August 1, 2023 (PDF)

Authorization Grid Detail, Effective July 1, 2023 (PDF)

Authorization Grid Detail, Effective June 1, 2023 (PDF)

Authorization Grid Detail, Effective May 1, 2023 (PDF)

Authorization Grid Detail, Effective April 1, 2023 (PDF)

Authorization Grid Detail, Effective February 1, 2023 (PDF)

Authorization Grid Detail, Effective January 1, 2023 (PDF)

Pharmacy - Electronic Prior Authorizations

Fidelis Care has made submitting Pharmacy electronic prior authorizations (ePA) easier and more convenient. ePA is Fidelis Care's preferred method to receive prior authorizations. 

We have partnered with ePA vendors, CoverMyMeds and Surescripts, making it easy for you to submit and access electronic prior authorizations via the ePA vendor of your choice. For more information on how to get started and to sign up, view Electronic Prior Authorizations

Behavioral Health & Utilization Management

Fidelis Care's Utilization Management Department can provide authorization assistance from 8:30 a.m. to 5 p.m. Monday through Friday except on holidays.

For urgent situations that cannot wait until the next business day, please call 1-888-FIDELIS (1-888-343-3547) for access.


Delegated Vendor Authorization Programs

Fidelis Care has engaged the following vendors to assist with utilization management.

Evolent

Delegated vendor who manages prior authorization requestsfor: Radiology Cardiology, Radiation Oncology, MusculoskeletalSurgery, Physical Therapy Services, Occupational Therapy Services, andSpeech Therapy Services.

Submit Prior Authorizations via Evolent

2026

2025

2024


Fidelis Care Medical Specialty Solutions – Provider Training Guide

Fidelis Care Physical Medicine Program - Provider Training Guide

Fidelis Care Physical Medicine FAQ


Provider Tip Sheets

Provider Tip Sheet: Physical Medicine

Provider Tip Sheet: Spine MRI and Spine CT

Provider Tip Sheet: Cardiac Solution Program

Provider Tip Sheet: Transthoracic Echocardiography (TTE)


Quick Reference Guides (QRG)

Quick Reference Guide: Physical Medicine

Quick Reference Guide: Cardiac Imaging Studies

Quick Reference Guide: Medical Specialty Solutions | For Ordering and Rendering Providers

Evolent Oncology Program

Oncology Services - Medicaid Managed Care and HealthierLife


Oncology Services - Essential Plan and Metal-Level Products (QHP)


Oncology Services - Medicare | Wellcare by Fidelis Care

Provider Access Online

Verify member eligibility or renewal status, check claims, submit authorization requests, send e-scripts, and more.

 

Manuals, Forms and Policies

Provider manuals, tip sheets, important forms, and applications.

Pharmacy Services

Formularies, utilization management programs, and specialty drug programs.