Welcome, Providers!

 

LATEST NEWS


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.

eviCore Healthcare

Access the eviCore utilization management system.

Electronic Transactions

Submit claims electronically with Fidelis Care.

Join Our Provider Network

Be part of the Fidelis Care mission. 

Important Information on Coverage Decisions

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

Fidelis Care does not reward practitioners or other individuals for issuing denials of coverage, and does not offer financial incentives to UM staff that would encourage decisions that result in underutilization of services. 

Fidelis Care is committed to ensuring that members have the care and services they need. 

Learn about Fidelis Care's Quality Management Program


Provider Access Online

Verify member eligibility, check claims status, and more.

Provider Bulletin

Read the latest Provider Bulletin and browse the archives.

Manuals and Forms

Provider manuals, tip sheets, important forms, and applications.