12/21/2020

Fidelis Care-Auth Requirements

Can you clarify the post regarding the changes in Fideliscare authorization requirements? It would appear from what is posted on their portal that only the mediCARE plans do not require authorization, and that the mediCAID and essential plans still require authorizations for all patients other than diabetics.

That is correct- the general rule with authorizations for Fidelis Care members is that services rendered to patients enrolled in the Medicare Advantage plan do not require authorization when performed in the office setting, and unless a patient is diabetic, all services for patients in the Medicaid or essential/metal plans do require authorization. Authorization requirements are updated for all plans are updated frequently by the managed care plan, but these general rules for podiatry remain in place. When services are provided in another place of service, such as home or the hospital, regardless of the plan, will require to be authorized in order for Fidelis Care to cover the procedures or items to be covered, even if they have no pre-certification in the office.