Fidelis Care has engaged National Imaging Associates, Inc. (NIA) to implement a new authorization program to manage outpatient rehabilitative and habilitative physical medicine services, including services rendered in the home, for services rendered on or after October 1, 2019.
The delegation of Prior Authorization to TurningPoint Healthcare Solutions, LLC has been delayed until further notice and is pending New York State approval.
In the interim, for services on or after October 1, 2019, Prior Authorization will be required for orthopedic surgical procedures and spinal surgical procedures, for both inpatient and outpatient settings, through Fidelis Care’s Authorization Department via Provider Access Online (provider portal), Fax: (800) 860-8720 , or Phone: (888) 343-3547.
The following sections of the Fidelis Care authorization grids have been updated effective October 1, 2019. The following services require prior authorization based on the health insurance product as outlined below:
Fidelis Care is pleased to inform you that the most recent 2019 QARR Non-Compliance Report has been posted on Provider Access Online (provider portal). This information is indicative of all encounter data on file with Fidelis Care as of 07/15/2019.
Effective October 1, 2019, Ovulation enhancing drugs and related medical services are covered when billed with the appropriate infertility diagnosis codes: