Submit Authorization Requests

This page explains the systems available to submit authorization requests

 

Doctors-Three-Bubbles


Fidelis Care has engaged the following vendors to assist with utilization management for evaluation of medical necessity, appropriateness, and delivery of care to our members.  Below you will find information and links to external vendor authorization programs as well as links to internal Fidelis Care prior authorization submission resources.

 

Delegated Vendor Authorization Programs

 Click to download provider tip sheets and follow links to Fidelis Care prior authorization submission resources. 

eviCore Healthcare
Delegated vendor who manages prior authorization requests for:  Outpatient High-Tech Radiology services, Outpatient Non-Obstetrical Ultrasounds, Outpatient Diagnostic Cardiology Services, and Outpatient Radiation Therapy Services.

Provider Tip Sheet: eviCore Program

Submit Prior Authorizations via eviCore Healthcare
National Imaging Associates, Inc. (NIA)

Delegated vendor who manages prior authorization requests for: Physical Therapy Services, Occupational Therapy Services, and Speech Therapy Services.

Provider Tip Sheet: National Imaging Associates, Inc. (NIA)

Submit Prior Authorizations via NIA

TurningPoint Healthcare Solutions

Delegated vendor who manages prior authorization requests for: Orthopedic Surgical Procedures and Spinal Surgical Procedures.

Provider Tip Sheet: Musculoskeletal Surgical Procedures Requiring Prior Authorization

Submit Prior Authorizations via TurningPoint Healthcare Solutions

Pharmacy – Electronic Prior Authorizations
Use the links below for more information on how to submit electronic pharmacy prior authorizations via Covermymeds® and Surescripts®

Electronic Prior Authorization Tip Sheet

Submit Prior Authorizations via:  Covermymeds or Surescripts

Need an Account?

   With Provider Access Online, you can:

  • View Patient Information, Get Claims Details, See Eligilibilty / Benefits, Submit Authorizations, and Download Provider-specific Documents.

Don't have an account?  Submit a request for access

Authorization Resources

To submit prior authorization request types, use the Fidelis Care provider portal.


 

Forms and Applications

For a complete list of Treatment/Service Request Forms, please visit Forms and Applications


 

Pharmacy Services

Formularies, utilization management programs, and specialty drug programs.