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Coronavirus and the Suspension of Certain Utilization Review Requirements (Updated)
1/31/2022 • Posted by Provider Relations

As recommended in New York State Department of Financial Services Insurance Circular Letter No. 1 dated January 6, 2022, Fidelis Care has suspended the following prior authorization requirements for Medicare products:

Hospital to Hospital transfer between participating facilities

  • The hospital is expected to use its best efforts to provide notice to Fidelis Care within 48 hours of the transfer.
  • Please include information necessary for Fidelis Care to assist in coordinating care and discharge planning.

Skilled Nursing Facilities (SNF)

  • Providers will have up to 7 days to notify Fidelis Care of the admission. 
  • Fidelis Care will approve the first 7 days of the stay, and will conduct concurrent review for all days beyond day 7

 

Fidelis Care will continue to monitor guidance from New York State.

 

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Member Renewal Information

Health insurance will no longer be automatically renewed for Medicaid Managed Care, Essential Plan, Child Health Plus, or HealthierLife members.

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Required Cultural Competency Training

Access the Provider Attestation Statement and submit completion of training.

Authorization Resources

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

Electronic Transactions

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Utilization Management (UM)

Find information and links to external vendor authorizations and to internal resources.