UPDATE: Fidelis Care Authorization Grids Effective June 1, 2022
4/29/2022
•
Posted by Provider Relations
The following sections of the Fidelis Care authorization grids have been updated effective June 1, 2022.
The Medicaid Plan grid has been updated as follows:
Children’s Home and Community Based Services
7. Respite Services (Planned Respite and Crisis Respite) EFFECTIVE 6/1/22, notification is no longer needed for Respite Services.
Pharmacy:
The following codes have been added to the Medicaid authorization grid and requires prior authorization:
J2278 ziconotide (Prialt)~
J8670 rolapitant (Varubi)
~ authorization is required for NYM/HARP members; it is not required for CHP members
The Medicaid, Essential Plan, Medicare, & Metal Level Plan grids have been updated as follows:
Durable Medical Equipment/Supplies:
4. Supplies requiring authorization:
b. Electric breast pumps (codes E0602 and E0603) have been removed and no longer require authorization.
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.