Submit Authorization Requests

This page explains the systems available to submit authorization requests

 

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Helpful Resources | Utilization Management (UM)

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
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

Behavioral Health & Utilization Management

For Prior Authorization of Behavioral Health services, please see the following contact information:

Phone: (718) 896-6500 ext. 16072 

Email: qhcmbh@fideliscare.org

Fax: (718) 896-1784


For Provider Manuals, Forms and Policies (Including Behavioral Health Request Forms), please click here



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.

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