Update to Concurrent Review Process for Hospitalized Members
2025/9/30
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Posted by Provider Relations
Effective November 1, 2025, Fidelis Care will begin outreaching for additional clinical information if a member remains hospitalized beyond seven (7) days. This outreach will initiate a concurrent review to assess medical necessity and support discharge planning activities.
Please note the following important updates:
- Initial approvals for emergent admissions and some elective admissions will no longer reflect a 30-day authorization period.
- Instead, ongoing hospitalization beyond 7 days will require submission of updated clinical documentation to support continued stay.
- Fidelis Care already conducts outreach for additional clinical information in cases where a member remains hospitalized for greater than 30 days. This new process expands that approach to earlier stages of hospitalization to better support care coordination.
- We recognize that many providers already submit clinical documentation at regular intervals, and we sincerely appreciate your continued collaboration in ensuring timely and appropriate care for our members.
These changes are designed to promote proactive discharge planning and ensure alignment with medical necessity criteria throughout the member’s stay.
We appreciate your partnership and commitment to delivering high-quality care.
For additional questions, or if we can be of assistance in any way, please contact your Fidelis Care Provider Engagement Account Manager. To find your designated representative, please visit Contact Your Designated Provider Relations Specialist.