Authorization, Utilization Review, and Behavioral Health Coverage Updates
Updates to Fidelis Care authorization, utilization review, and coverage procedures that affect behavioral health, substance use disorder, inpatient and outpatient services and selected specialty services in New York State.
OMH licensed inpatient mental health treatment in NYS is not subject to authorization review when provided by OMH licensed hospitals, with notification required within 2 business days of admission.
OASAS licensed in-state inpatient SUD services are not subject to authorization review and not subject to concurrent utilization review during the first 28 days when notification and initial treatment plan requirements are met.
In-network, in-state outpatient substance use services do not require provider notification, authorization, or concurrent authorization review effective 01/01/2020.
Prior authorization delegations and vendor transitions clarified for certain surgical categories (TurningPoint, Evolent/NIA).
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.