FidelisCare New York

Authorization Grids Update: Effective from August 1, 2022 
Medicare, Medicaid, The Essential Plan and Metal-Level Products grids have been updated as per the following. 
Outpatient and DME Services: If a therapy provider performs Home & Outpatient Physical Therapy (PT), Occupational Therapy (OT) and Speech Therapy (ST) after the initial evaluation then it will require prior authorization through NIA. Note that, CPT codes 92610 and 92611 are free from this obligation.  
All other billed procedure codes will require authorization prior to billing. If a claim gets submitted without designated CPT codes, it is necessary to send an authorization request to NIA within 1 business day for the outpatient setting. For the home health setting, it is to be done within 2 business days.  
For all therapy services in Inpatient settings POS 31 and 32 you can fax prior authorization requests to 716-803-8307. Non-Therapy Providers can also send prior authorization request for all services. However, it is only possible after the initial evaluation is completed by Fidelis Care.  
Source: FidelisCare provider newsletter 
Provider Portal is now more enriched with information about Pending Authorization Status Letters 
Fidelis Care’s Provider Portal ‘Provider Access Online’ now shows the status of the pending authorization letters. This secure and easy-to-use platform now provides all information about the patient 24/7.  
You can download the following letters from Fidelis Care’s smart portal.  

• Appeal Approved and Out-of-Network Denied Letter 
• Admission Approval Letter 
• Appeal Denial Letter 
• Appeal Decision Letter 
• Approval Letter 
• Approved Out-of-Network and Appeal Denial Letter 
• Authorization Request Extension Letter 
• Authorization approved and Out-of-Network Denied Letter 
• Denial Letter 
• Exhausted Benefit Denial Letter 
• Partial Appeal Denial Letter and Partial Denial Letter 
• Pending Authorization Letter 
• Reconsideration Request Approval Letter 

The step-by-step process of checking the status of an authorization request is mentioned in their portal/website. Link to the portal: 

https://providers.fideliscare.org
Source: FidelisCare provider newsletter 
Patient’s Eligibility and Benefits can be Checked Through Self-Service Tools 
From August 15, 2022, Fidelis Care Providers can get access to patients’ eligibility and benefits through Fidelis Care’s Provider Portal or the Automated Eligibility system on their IVR at 1-888-343-3547. 
So, without any waiting period, a provider’s staff can learn everything related to the eligibility and benefits of a patient. It is noted that the Call Center is not authorized to provide any information regarding this.