Utilization Management Appeals Delegation for ENT and Cardiovascular Services
2026/9/1
•
Posted by Provider Relations
in
Provider News
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 directly to TurningPoint.
Appeal Submission Timeframes
Medicaid and Child Health Plus
- Providers will have 60 calendar days to submit an appeal request to TurningPoint following receipt of the determination notice.
- Standard appeal determinations will be issued within 30 calendar days of submission.
- Expedited appeal determinations will be rendered within 2 business days (not to exceed 72 hours) following submission.
Ambetter from Fidelis Care and Essential Plan
- Providers will have 180 calendar days to submit an appeal request to TurningPoint following receipt of the determination notice.
- Standard appeal determinations will be issued within 30 calendar days of submission.
- Expedited appeal determinations will be rendered within 2 business days (not to exceed 72 hours) following submission.
Specific instructions and timelines will be included in the appeal notification.
Provider Support and Contact Information
TurningPoint’s Provider Relations team is available to assist with questions related to UM appeals, precertification, or intake.
TurningPoint Provider Relations
TurningPoint Utilization Management & Precertification Intake
Additional Information
A copy of this notice, along with a detailed list of impacted CPT codes, will be available on our website at https://www.fideliscare.org/Provider/Provider-Resources/Authorizations.
We appreciate your continued partnership and cooperation as we work to streamline utilization management processes and support high-quality care for our members.