Written Member Consent Required for Authorization Appeals Effective June 1, 2025
4/29/2025
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Posted by Provider Relations
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Provider News
Due to regulatory requirements defined in Article 44 of the New York State Public Health Law for all Managed Care Organizations (MCO), Fidelis Care is implementing changes to our Utilization Management/Authorization Appeals process. Effective June 1, 2025, Fidelis Care will require providers to adhere to a new procedure related to utilization management/authorization appeals.
As of June 1, 2025, Fidelis Care will require a written member consent to process any provider initiated post-decision appeal review requests. Member consent can be submitted the following ways:
- Member or the member’s assigned designee signs the designated area on the Appeal Request Form, which is included with the initial adverse decision, consenting to the appeal.
- Member or the member’s assigned designee signs an appeal consent written by the provider or member.
Once the consent has been obtained, providers are required to submit the proof of consent with the authorization appeal, along with any other supporting documentation*, by attaching it to the appeal in the Provider Portal or through the standard appeal process.
Should Fidelis Care receive an authorization appeal that does not include a member consent, a Fidelis Care representative will contact the provider to obtain the written member consent, during which time the Appeal Request will be pending. If the member consent cannot be obtained, the appeal will be dismissed, and Fidelis Care will notify the provider and member accordingly. The appeals processing time will begin once the Member Consent is submitted to the Plan.
For additional questions, or if we can be of assistance in any way, please contact your Fidelis Care Provider Engagement Account Manager. To find your designated representative, please visit Contact Your Designated Provider Relations Specialist.
*Please note: Once a determination has been made, a notice will be sent to both the provider and the member. The Member Case File will include any supporting documentation included with the appeal. Providers may want to consider sending the necessary documentation for the appeal, rather than the member’s complete medical chart.