Fidelis Care Authorization Grids Effective December 1, 2021
11/2/2021
•
Posted by Provider Relations
The following sections of the Fidelis Care authorization grids have been updated effective December 1, 2021.
The Outpatient and DME Services section of the Medicaid, Medicare, Essential Plan, & Metal Level Plan grids now include the following updated verbiage regarding National Imaging Associates, Inc. (NIA):
Outpatient and DME Services: The following services require prior authorization:
- Imaging Studies: Effective 9/20/2021 for dates of service rendered on or after 10/1/2021, prior authorization has been delegated to National Imaging Associates, Inc. (NIA) healthcare for radiology services. Please note, besides the cardiac ultrasounds delegated to TurningPoint, many ultrasounds (i.e. non-OB pelvic ultrasounds, abdominal ultrasounds, fetal echocardiograms) do not require prior authorization and full list of CPT codes can be found by clicking here.
The following verbiage has been added to Medicaid Grid regarding Children’s Home and Community Based Services:
- Children’s Home and Community Based Services, Effective 10/1/19:
Effective 12/01/2021, Providers are required to submit Section 1 of the NYS DOH Children’s HCBS Authorization and Care Manager Notification form prior to initiating Children’s HCBS services to Fidelis Care by email SM_Childrens_HCBS@fideliscare.org, fax (347) 690-7362 or by calling 1-888-FIDELIS (1-888-343-3547) and following the prompts for Children’s Medicaid.
Notification should be submitted prior to rendering the service to prevent disruptions in claims processing. C-YES and Health Home providers are responsible for submitting the Plan of Care to Fidelis to comply with the Children’s HCBS workflow requirements. Once the required documentation is submitted, you will be notified verbally of the determination. You and the member will receive a letter communicating the details of the determination.
Providers should not wait until the initial authorization expires before requesting concurrent review. As soon as frequency, scope, and duration are determined, the form must be submitted before the end of the existing authorization to reduce risk of claims processing delays.
Visit: Authorization Grids
COVID-19 UPDATE: Please refer to this link: Important Updates Regarding Coronavirus COVID-19, for authorization and coding guidelines related to the COVID-19 Pandemic.