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LATEST NEWS


Coronavirus and the Suspension of Certain Utilization Review Requirements (Updated)
1/31/2022 • Posted by Provider Relations

As recommended in New York State Department of Financial Services Insurance Circular Letter No. 1 dated January 6, 2022, Fidelis Care has suspended the following prior authorization requirements for Medicare products:

Hospital to Hospital transfer between participating facilities

  • The hospital is expected to use its best efforts to provide notice to Fidelis Care within 48 hours of the transfer.
  • Please include information necessary for Fidelis Care to assist in coordinating care and discharge planning.

Skilled Nursing Facilities (SNF)

  • Providers will have up to 7 days to notify Fidelis Care of the admission. 
  • Fidelis Care will approve the first 7 days of the stay, and will conduct concurrent review for all days beyond day 7

 

Fidelis Care will continue to monitor guidance from New York State.

 

Smiles-that-Shine

 

Required Cultural Competency Training

Access the Provider Attestation Statement and submit completion of training.

Authorization Resources

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

Electronic Transactions

Submit claims electronically for faster processing and reimbursement.

Provider Access Online

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

Utilization Management (UM)

Find information and links to external vendor authorization programs as well as links to internal Fidelis Care prior authorization resources.

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