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Pharmacy Prior Authorization Process Effective June 1, 2020
5/10/2020 • Posted by Provider Relations

WellCare New York members enrolled in Medicaid, Child Health Plus, and Essential Plans products* will transition to and become Fidelis Care members effective June 1, 2020.  These members will be issued a Fidelis Care member identification card; therefore, the transition may be transparent.

 

Pharmacy Prior Authorizations requests for these plans and transitioned members should be faxed to 1-877-533-2405, which is our same Medicaid fax number.  Please use the existing Medicaid fax authorization form found here:  NYS Medicaid Prior Authorization Request Form For Prescriptions

 

*Note:  WellCare New York members enrolled in a Managed Long Term Care product are transitioning to Fidelis Care as well effective June 1, 2020; however, they will not be affected by the above pharmacy authorization process.

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

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Important Information on Coverage Decisions

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. 

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

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