5/23/2019
•
Posted by Provider Relations
The following sections of the Fidelis Care authorization grids have been updated effective July 1, 2019.
The following services apply to Medicaid, Child Health Plus, and HealthierLife (HARP) lines of business and require prior authorization:
IV. Behavioral Health – Outpatient Services:
D. Partial Hospitalization (Mental Health and/or Substance Abuse):
Requests for members under 21 can be made by email chmmc@fideliscare.org, fax (347) 690-7362 or by calling 1-888-FIDELIS (1-888-343-3547) and following the prompts for Children’s Medicaid. (added)
G. Mental Health Continuing Day Treatment:
Requests for members ages 18-20 can be made by email chmmc@fideliscare.org, fax, (347) 690-7362 or by calling 1-888-FIDELIS
(1-888-343-3547) and following the prompts for Children’s Medicaid. (added)
H. Personalized Recovery Oriented Services (PROS):
Requests for members ages 18-20 can be made by email chmmc@fideliscare.org, fax, (347) 690-7362 or by calling 1-888-FIDELIS
(1-888-343-3547) and following the prompts for Children’s Medicaid. (added)
I. Assertive Community Treatment (ACT):
Requests for members ages 18-20 can be made by email chmmc@fideliscare.org, fax, (347) 690-7362 or by calling 1-888-FIDELIS
(1-888-343-3547) and following the prompts for Children’s Medicaid. (added)
O. Children and Family Treatment and Support Services (CFTSS):
Effective July 1, 2019, an additional CFTSS will be available to Medicaid recipients under age 21:
4. FPSS – Family Peer Support Services (H0038)
Fidelis Care will not conduct prior authorization review for the first 3 CFTSS visits.
However, concurrent review is required prior to the 4th visit. Providers must submit the
CFTSS Authorization Request Form by email or fax, (347) 690-7362 prior to the 4th visit.
Providers may also contact Fidelis by telephone at 1-888-FIDELIS (1-888-343-3547) and
follow the prompts. (added)
P. Children’s BH Carve-In: Effective July 1, 2019:
|
Name of Service
|
Authorization Requirement
|
Age Requirement
|
Medicaid Benefit Status (New or Previously covered)
|
Medicaid -SSI Benefit Status (New, Previously covered, Carve-In)
|
|
OMH designated Serious Emotional Disturbance (SED) Clinic Services
|
None
|
Under 19
|
New
|
New
|
|
OMH Outpatient Services
|
None
|
Under 21
|
Previously covered
|
New
|
|
Psychiatric Services
|
None
|
Under 21
|
Previously covered
|
New
|
|
Psychological Services
|
None
|
Under 21
|
Previously covered
|
New
|
|
Partial Hospitalization Program
|
Prior Auth, Concurrent Review
|
Under 21
|
New
|
New
|
|
Assertive Community Treatment (ACT)
|
Prior Auth, Concurrent Review
|
18-20
|
New
|
New
|
|
Continuing Day Treatment
|
Prior Auth, Concurrent Review
|
18-20
|
New
|
New
|
|
Personalized Recovery Oriented Services (PROS)
|
Prior Auth, Concurrent Review
|
18-20
|
New
|
New
|
|
Inpatient Psychiatric Services
|
Prior Auth, Concurrent Review
|
Under 21
|
Previously covered
|
New
|
|
Comprehensive Psychiatric Emergency Program
|
None
|
Under 21
|
Previously covered
|
New
|
|
Outpatient – Clinic
|
None
|
Under 21
|
New
|
New
|
|
Outpatient – Rehabilitation Programs
|
Concurrent
|
Under 21
|
New
|
New
|
|
Opioid Treatment Program Services
|
Concurrent
|
Under 21
|
New
|
New
|
|
Chemical Dependence Inpatient Rehabilitative Services
|
Prior, Concurrent
|
Under 21
|
Previously covered
|
New
|
Requests for services listed above for members under age 21 can be made by email
chmmc@fideliscare.org, fax, (347) 690-7362 or by calling 1-888-FIDELIS (1-888-343-3547)
and following the prompts for Children’s Medicaid.
(added)
Visit:
Authorization Grids