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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:  

Fidelis Care has updated its 30-Day Readmission Payment Policy which establishes reimbursement guidelines for hospital readmissions occurring within thirty (30) days of discharge. This policy replaces the previous 14-Day Readmission Payment Policy and expands the readmission review period to thirty (30) days following discharge. The updated policy, effective October 1, 2026, outlines circumstances when a readmission may not qualify for separate reimbursement. Certain readmissions may be reviewed to determine whether they meet Fidelis Care’s reimbursement criteria. When applicable, separate payment for the readmission may be denied because the readmission is considered an extension of the initial admission. Providers should review the policy