Yesterday
• Posted by Provider Relations
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
Yesterday
• Posted by Provider Relations
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
Tuesday
• Posted by Provider Relations
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
Tuesday
• Posted by Provider Relations
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
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