2025/5/30
• Posted by Provider Relations
• in
Provider News
Fidelis Care would like to notify our providers of an update to our Children and Family Treatment and Support Services (CFTSS) Utilization Review Process. Effective July 1, 2025, Fidelis Care will begin Utilization Management on certain CFTSS Services with a service date of July 1, 2025 or later. Services rendered and billed through June 30, 2025, will process with no authorization requirements.
Fidelis Care will require notification of the initiation of CFTSS Services, and provider must request prior authorization after the 3rd Visit for the following services.
Other Licensed Practitioner (OLP)
Community Psychiatric Supports and Treatment (CPST)
Psychosocial Rehabilitation (PSR)
Family
2025/5/29
• Posted by Provider Relations
• in
Provider News
The following section of the Fidelis Care authorization grids have been updated effective July 1, 2025.
The following DME codes have been removed from the Medicaid, Essential Plan, and Ambetter Metal-Level Products Authorization Grids and no longer require prior authorization:
K0001 Standard wheelchair
L0621 SIO flex pelvisacral prefab
L2630 Pelvic control band and belt B
L3809 Whfo w/o joints pre ots
The following code has been updated on the Medicaid, Essential Plan, and Ambetter Metal-Level Plans Authorization Grids and requires prior authorization:
Q0224 pemivibart (Pemgarda)
The following codes have been updated on the Medicare, Medicaid, Essential Plan, and Ambetter Metal-Level Plans Authorization Grids and require prior authorization:
C9174 datopotamab deruxtecan-dlnk
2025/5/19
• Posted by Provider Relations
• in
Provider News
The Centers for Medicare and Medicaid Services (CMS) requires that providers receive Medicare Special Needs Program (SNP) Model of Care (MOC) Training annually. As part of our ongoing commitment to access, quality of service, and quality of care for our members, Fidelis Care provides this training annually and during the new contract process to all network providers, as well as to providers who regularly see our SNP members.
The training module can be accessed by logging into our provider portal, please visit Provider Access Online. After logging in, if training and attestation is required, you will receive a notification on the Home Page.
2025/5/16
• Posted by Provider Relations
• in
Provider News,
Provider Quality
Fidelis Care will host three Provider Office Hours in June 2025. During the webinars, Fidelis Care staff will be available to share information, provide an overview of provider resources, and answer your questions.
Provider Office Hours – June 2025
Topic: Behavioral Health Overview
When: Thursday, June 12th – 11 AM – 12 PM EST
Click here to register*
Topic: Fidelis Care and Wellcare - Quality Programs
When: Wednesday, June 25th – 10 AM – 11 AM EST
2025/5/16
• Posted by Provider Relations
• in
Provider News
The following codes on the Evolent/Fidelis Care authorization grid have been updated effective June 1, 2025.
The following codes have been removed from the Evolent Radiology Cardiology Utilization Review Matrix and no longer require prior authorization for Wellcare by Fidelis Care, Medicaid, Essential Plans, and Ambetter Metal-Level Products:
Transthoracic Echocardiogram - 93307, 93303, 93304, 93306, 93307, 93308, 93320, 93321, 93325, 93356
Chest CT - 71250, 71260, 71270, 0722T
CT for Low Dose Lung Cancer Screening - 71271
Visit: Authorization Requests
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