Behavioral health authorization and service carve-in rules
Defines Fidelis Care authorization requirements for inpatient and outpatient behavioral health and substance use services, delegates certain prior authorizations, and describes the January 2023 Medicaid MAP behavioral health carve-in for New York members.
Effective 1/1/2023, additional Behavioral Health Services are carved into the Medicaid Advantage Plus (MAP) Plan benefit package.
Effective 01/01/2020, in-state OASAS licensed inpatient SUD facilities in-network are not subject to prior authorization and not subject to concurrent utilization review for the first 28 days provided notification and LOCADTR procedures are followed.
Effective 01/01/2020, OMH-licensed inpatient mental health treatment for members under 18 in-network is not subject to prior authorization and not subject to concurrent review for the first 14 days provided two-day notification and daily review requirements are met.
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.