New Authorization Lookup Tool for Medicaid to Help Streamline Authorization Process
2023/11/21
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Posted by Provider Relations
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Provider News
Fidelis Care is pleased to announce a new Medicaid Authorization Requirement Lookup Tool to help improve the experience of providers. The new, web-based tool will help providers determine which procedure codes require pre-authorization for Medicaid, Child Health Plus, LTSS, Essential Plan, and HARP products.
You can also navigate to the tool from the fideliscare.org home page.
- Go to Providers
- Under Provider Resources, find Authorization Grids
- Click on the "Medicaid, Child Health Plus, HealthierLife (HARP)" drop-down
- Select “Medicaid Authorization Lookup Tool”
This initial release will focus on Medicaid plans, with future updates to support Medicare plans and Qualified Health Plans. Those updates will be located in their respective sections upon their release.
Some of the benefits of the new Lookup Tool include:
- Faster Determinations: Providers can more quickly determine whether a code needs prior authorization.
- Real-Time Procedure Code Updates: Experience quicker updates to both new and existing procedure codes, enabling more accurate and timely information.
For further information, review the Authorization Lookup Tool Reference Guide. If you have any questions, please contact your Fidelis Care Provider Relations Specialist.
We are excited to share this tool with you, and we appreciate your continued partnership.
DISCLAIMER: While every effort is made to provide the most current information on the Pre-Authorization Tool, it is important to note that this does not guarantee payment or confirm patient eligibility. For specific details, please refer to the current authorization grids and provider manual. If you are uncertain whether prior authorization is needed, please submit a request for authorization through the Provider Portal.
If a code is not found or is deemed “conditional” while using the tool, providers should refer to the authorization grids located here. If still uncertain whether prior authorization is required, providers should submit a request for authorization through the Provider Portal.