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UPDATE - Musculoskeletal Surgical Procedures Authorization Program Beginning October 1, 2019
9/6/2019 • Posted by Provider Relations

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.

This authorization program is designed to work collaboratively with physicians to promote patient safety through the practice of high quality and cost-effective care for Fidelis Care members undergoing Musculoskeletal Surgical Procedures.

The program will include the following Fidelis Care health insurance products:

     Medicaid Managed Care (NYM)            HealthierLife (HARP)
     Child Health Plus (CHP)                          Metal-level Products (qualified health plan)
     Medicare Advantage (MA)                      Essential Plan (EP)
     Dual Advantage (DUAL)                          Medicaid Advantage Plus (MAP)

A list of procedures requiring prior authorization can be found here:
Musculoskeletal Surgical Procedure Codes List

Additional updates and TurningPoint Healthcare Solutions training opportunities/dates for providers will be shared as they become available.

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

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Each day, Fidelis Care's Utilization Management (UM) Department makes decisions on many health insurance claims. These decisions are based only on appropriateness of care and the existence of coverage. 

Fidelis Care does not reward providers or other individuals for issuing denials of coverage, and does not offer financial incentives to UM staff based on decisions that promote underutilization of services. 

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