Behavioral Health and COVID-19 Authorization Updates — Coverage & Authorization Criteria
Governs authorization, utilization review, and coverage rules for behavioral health services and related COVID-19 updates for Fidelis Care Medicaid/CHP members in New York State.
Effective 6/1/23 providers will no longer need to obtain authorization from Fidelis Care for ACT services using code H0040; SPOA will manage ACT placement and referral process.
Effective February 1, 2022, PROS and CORE services do not require prior authorization but require specific initiation/notification forms to be submitted to Fidelis within specified timeframes.
CFTSS are covered under the CHP benefit package effective 1/1/23 and prior authorization was never required for these services.
Children's HCBS respite service flexibilities ended; respite must be delivered in-person and telehealth/telephone delivery is no longer allowed.
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.