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Fidelis Care Authorization Grids Effective February 1, 2022
1/14/2022 • Posted by Provider Relations

The following sections of the Fidelis Care authorization grids have been updated effective February 1, 2022.

The Medicaid Authorization Grid has been updated as follows:

 

IV.        Behavioral Health - Outpatient services

  • Personalized Recovery Oriented Services (PROS):  Effective February 1, 2022, Prior authorization is not required for Personalized Recovery Oriented Services (PROS).  Prior to this date, prior authorization was required.

 

  • Home and Community Based Services (HCBS) are available if determined to be eligible through enrollment in the adult HealthierLife plan and in conjunction with a completed evidence based eligibility assessment. The intake period (3 visits or 14 days) do not require prior authorization. Prior authorization is required after completing the intake visits and are to be submitted to Fidelis Care by e-mail (QHCMHARPBH@FidelisCare.org) or fax (347-868-6427) for approval.

These services are categorized as adult behavioral health-HCBS:

  1. Habilitation and Residential Support Services; T2017
  2. Pre-Vocational Services:  T2015
  3. Transitional Employment; T2019
  4. Supported Employment; H2023, H2025
  5. Education Support Services; T2013
  6. Provider Travel Supplement; A0160

 

 

  • Effective February 1, 2022: Community Oriented Recovery and Empowerment (CORE) Services are available if determined to be eligible through enrollment in the adult HealthierLife plan and in conjunction with a supporting Licensed Practitioner of the Healing Arts (LPHA) Recommendation Form completed by a qualifying healthcare provider. Services do not require prior authorization. The Service Initiation Form is required to be submitted to Fidelis Care by e-mail (QHCMHARPBH@FidelisCare.org) or fax (347-868-6427) within 3 business days of the first service visit.

These services are categorized as CORE Services:

  1. Psychosocial Rehabilitation;  H2017
  2. Community Psychiatric Support and Treatment (CPST); H0036
  3. Empowerment Services (Peer Supports); H0038
  4. Family Support and Training; H2014
  5. Provider Travel Supplement; A0160

 

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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.

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