Bienvenidos, Corredores!

As you may be aware, Section 12006 of the 21st Century Cures Act, along with CMS guidance, required states to implement Electronic Visit Verification (EVV) for Personal Care Services by January 1, 2021, and for Home Health Care Services by January 1, 2023. As of 2026, EVV requirements are fully implemented, requiring applicable services to be electronically verified and documented, including the member receiving care, caregiver, service location, date, and type of service provided.   Next Steps To ensure EVV data is accurately captured for providers delivering in-scope EVV services, Fidelis Care will require all providers — including existing EDI and Enterprise (ENT) providers — to submit

Recovery is possible. Treatment works. And as healthcare professionals, we play a critical role in helping individuals take the first step toward recovery. At Fidelis Care, we recognize that substance use disorder (SUD) is a chronic, treatable medical condition. Yet despite advances in treatment and growing awareness, stigma remains one of the greatest barriers preventing individuals from seeking care, engaging in treatment, and sustaining recovery. Through our End the Stigma Initiative, Fidelis Care is committed to promoting recovery, increasing access to evidence-based treatment, connecting members to supportive services, and providing physicians and healthcare professionals with tools and resources to better serve individuals

The TurningPoint authorization grid has been updated effective October 1, 2026.           The following codes have been added to the TurningPoint authorization grid and require prior authorization: 37254-37295   Lower Extremity Revascularization 92930 and 92945  Coronary Angioplasty/Stenting   Visit:  Authorization Grids

Fidelis Care and TurningPoint Partnership Effective October 1, 2026, first-level Utilization Management (UM) appeals for ENT and cardiovascular surgeries and procedures will be managed by TurningPoint, our specialty benefits management partner. This update applies to members enrolled in the following Fidelis Care lines of business: Medicaid Child Health Plus (CHP) Essential Plan Ambetter from Fidelis Care (QHP) What Is Changing? Beginning October 1, 2026, TurningPoint will assume responsibility for first-level UM appeal reviews related to surgeries and procedures for the lines of business listed above. After a determination has been made on a case, providers will receive a notification outlining how to submit an appeal

Fidelis Care is notifying providers of key updates to the Applied Behavior Analysis (ABA) Clinical Policy (FC.CP.BH.104) The updated policy includes revisions to medical necessity criteria, treatment planning standards, and utilization management requirements for ABA services. Fidelis Care has also adopted a related policy CP.BH.105 ABA Documentation, outlining documentation standards to support medical necessity review and ongoing authorization requests.   In addition, CMS has released the State Medicaid and Children’s Health Insurance Program Applied Behavior Analysis Toolkit, which is being shared as a reference resource.   Effective 10/1/2026, the following changes, which are outlined in greater depth within the policy attached will apply: