CurrentFidelis CarePolicy N/A

COVID-19 update and authorization/coding guidance

Updates and operational guidance for authorization, utilization review, and coding during the COVID-19 pandemic and related changes to behavioral health, inpatient, outpatient, surgical, and DME services for Fidelis Care members in New York State.

Policy Summary

PayerFidelis Care

PolicyCOVID-19 update and authorization/coding guidance

Policy CodePolicy N/A

Change TypeNo material change

Effective DateJan 1, 2020

Next Review DateN/A

Key ActionNotify Fidelis Care within two business days of OMH- or OASAS-licensed inpatient admissions using the specified notification form to qualify for the concurrent-review waiver period.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

14 daysOMH concurrent waiver (under 18)

28 daysOASAS concurrent waiver

60Rehab visit limit

10 hrsCounseling allowance

40Home health max (plan yr)

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Coverage Criteria and Scope

OMH Licensed Inpatient Mental Health - Under 18

OMH-licensed inpatient mental health (members under 18) coverage condition

OMH under-18 inpatient authorization waiver conditions: Inpatient mental health treatment for members under 18 provided by OMH-licensed hospitals in New York State participating in Fidelis Care's network are not subject to authorization review and Fidelis Care will not conduct concurrent utilization review during the first 14 days provided that: (i) the facility notifies Fidelis Care of the admission and initial treatment plan within two business days using the OMH Two-Day Notification and Initial Treatment Plan form; (ii) the facility performs daily clinical review of the patient; and (iii) the facility participates in periodic consultation with Fidelis Care to ensure use of evidence-based, peer-reviewed clinical review criteria approved by OMH.14 days

Services may be reviewed retrospectively; inpatient services for members age 18 and older continue to require authorization and concurrent review.

OASAS Licensed Inpatient SUD

OASAS-licensed inpatient SUD coverage condition

OASAS inpatient SUD authorization waiver conditions: Inpatient detoxification, inpatient rehabilitation and inpatient residential SUD services provided by OASAS-licensed, in-state, in-network facilities are not subject to authorization review and are not subject to concurrent utilization review during the first 28 days of admission provided the facility: (i) notifies Fidelis Care of the inpatient admission and initial treatment plan within two business days using the OASAS Appendix A Notification Form and the LOCADTR tool; (ii) performs daily clinical review of the patient; and (iii) participates in periodic consultation with Fidelis Care. Services may be subject to utilization review after day 28 or upon discharge.28 days

Facilities outside NY State or out-of-network remain subject to authorization and concurrent review throughout admission.

Inpatient admissions and elective surgical procedures

General inpatient and elective surgery coverage stance

Inpatient admissions and elective surgery: All inpatient admissions require prior authorization and are reviewed for medical necessity. Many surgical and medical procedures completed within 24 hours will not be approved at an inpatient level of care and may be covered as outpatient without authorization when performed in-network; specific outpatient surgery and procedure codes listed in the policy require prior authorization.

Certain orthopedic/spinal authorizations are delegated to TurningPoint.

DME and supplies

DME and supplies coverage and authorization guidance

DME authorization and coverage: Orthotics are not covered. Other DME codes require prior authorization except for a specified list of HCPCS codes that do not require authorization. Certain supplies (for example electric breast pumps, compression garments/stockings, wigs, insulin pumps and insulin infusion pumps) require authorization.

Exact list of DME codes that do not require authorization is provided in the policy and must be used when submitting requests.

Outpatient therapy - Coverage criteria

Therapy services and visit limits

Outpatient PT/OT/ST authorization: Initial evaluations for PT, OT, and ST do not require authorization; however, all subsequent billed procedure codes (even if billed on the same date as the initial evaluation) require authorization through National Imaging Associates (NIA). This excludes services performed in inpatient, emergency room, skilled nursing facility, or observation settings. Non-therapy providers should request authorization for post-evaluation services directly through Fidelis Care.

Rehabilitation/habilitation visit limits: Rehabilitation and habilitation benefits are limited to 60 visits per condition per plan year; the visit limit applies to all therapies combined.60 visits per condition per plan year

Podiatry

Podiatry coverage

Podiatry authorization exceptions: Podiatric services do not require authorization for members with a confirmed diagnosis of Diabetes Mellitus (the diabetes diagnosis must be included on the claim). Podiatric services for members without diabetes require authorization. Routine foot care for non-diabetics is not covered. Podiatrists must obtain authorization for any DME supplied in-office regardless of member diagnosis.

Therapeutic services

Therapeutic services coverage notes

Non-covered services for Low Back Pain: The following services are not covered for members with a diagnosis of Low Back Pain: therapeutic facet joint steroid injections in the lumbar and sacral regions (with or without CT fluoroscopic guidance), continuous or intermittent traction, therapeutic injections of steroids into intervertebral discs, and other listed services in the policy.

See policy for the specific list of excluded services.

Cardiac and pulmonary rehabilitation delivered in outpatient settings require prior authorization; specific codes are listed in the policy (e.g., S9472, 93797-93798, G0422-G0424, G0237-G0239, S9473).

Pharmacy / enteral / specialty drug coverage

Pharmacy and specialty medications

Oncology medications and supportive agents require prior authorization from New Century Health for members age 18 and over in Medicaid Managed Care, Essential Plan, and Qualified Health Plan lines of business (excluding Child Health Plus). PA requests should be submitted via the NCH web portal or phone. Certain high-cost or specialty therapies (for example CAR T-cell therapy, Cablivi, immune globulins, sickle cell therapies and others listed) are reviewed directly by Fidelis Care and should not be submitted to NCH.

Contact NCH or Fidelis Care per policy guidance.

Enteral therapy and self-administered medications: Enteral therapy HCPCS codes B4034-B4162 require prior authorization. Self-administered medications are covered under the pharmacy benefit; certain self-administered and other specialty codes require authorization from the Pharmacy Team and requests should be submitted via e-fax as specified in the policy.

Fax number provided in policy for pharmacy PA submissions.

Authorization Required

Covered when authorization is obtained for listed codes; exceptions noted below

Authorization rule: Prior authorization is required for enteral therapy HCPCS codes B4034-B4162 and for the numerous J-codes listed in the policy. Requests must include the specific HCPCS or J-code and associated drug/item as mapped in the policy. Exceptions: authorization is not required for oncology indications for members under age 18 and is not required for ophthalmic indications.

Failure to obtain required authorization may result in claim denial; see policy for full J-code list and mapping.

Facilities that are outside New York State, not licensed/certified/authorized by OASAS, or outside Fidelis Care's provider network must request prior authorization for inpatient substance use disorder services and remain subject to concurrent utilization review for the entire admission. For OASAS‑licensed, in‑state, in‑network facilities, inpatient detoxification, inpatient rehabilitation and inpatient residential SUD services are not subject to authorization review and are exempt from concurrent utilization review during the first 28 days of the admission provided the facility: (1) notifies Fidelis Care of the admission and initial treatment plan within two (2) business days (OASAS Appendix A Notification Form and LOCADTR tool may be faxed or emailed); (2) performs daily clinical review; and (3) participates in periodic consultation with Fidelis Care. Services may be subject to utilization review after day 28 or upon discharge, and all care may be reviewed retrospectively for medical necessity.

Orthotics are explicitly listed as not covered. Routine foot care for members without Diabetes Mellitus is also not covered. Durable medical equipment and supplies generally require authorization except for a specified list of HCPCS codes that do not require authorization; certain supplies (for example, electric breast pumps, compression garments/gradient stockings, wigs, and insulin pumps/infusion pumps) do require authorization. For members with a diagnosis of Low Back Pain, several services are not covered, including therapeutic facet joint steroid injections in the lumbar and sacral regions (with or without CT guidance), continuous or intermittent traction, and therapeutic steroid injections into intervertebral discs (see full list in the Therapeutic Services section).

An explicit exception to the prior authorization requirement applies for oncology indications in pediatric patients: authorization is not required for oncology indications for members less than 18. Additionally, authorization is not required for ophthalmic indications per the listed guidance. Requests for enteral therapy and many J‑codes generally require authorization, but these pediatric oncology and ophthalmic exceptions override that requirement when applicable.

CPT code 96110 (developmental screening) is designated as a non‑covered service and should not be submitted for authorization or reimbursement under this policy.

For members diagnosed with Low Back Pain, the policy lists specific therapeutic services that are not covered. Examples include therapeutic facet joint steroid injections in the lumbar and sacral regions, continuous or intermittent traction, and therapeutic injections of steroids into intervertebral discs. Providers should refer to the Therapeutic Services section for the complete list of excluded procedures when billing for Low Back Pain diagnoses.

Coding and Code Lists

Transplant codes requiring authorizationCPTCovered

32850-32856	transplant-related codes (listed)
33930-33945	transplant-related codes (listed)
38204-38215	transplant-related codes (listed)
38230-38242	transplant-related codes (listed)
44133-44136	transplant-related codes (listed)
47133-47147	transplant-related codes (listed)
48160	transplant-related codes (listed)
48550-48556	transplant-related codes (listed)
50300-50380	transplant-related codes (listed)
50547	transplant-related codes (listed)

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Outpatient surgery and outpatient procedures requiring authorizationCPTCovered

11920-11971	breast reconstruction codes
19300	breast reconstruction/reduction
19316-19342	breast reconstruction codes
19355	breast reconstruction codes
19370-19396	breast reconstruction codes
10060	incision and drainage
11100	biopsy
11900	injection
17000	destruction of premalignant lesion
20600	aspiration/injection

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Behavioral health, testing, ECT, ASD, and residential treatment codesmixedCovered

96116	neuropsych testing code
96121	psych testing, administered by technician
96130	psych testing, interpretation
96131	neuropsych testing interpretation
96132	neuropsych testing, first hour
96133	neuropsych testing, each additional hour
96136	psych/pt testing
96137	psych/pt testing additional
96138	psych testing proctored
96139	psych testing each additional

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DME codes not requiring authorizationHCPCS

E0130	DME code not requiring authorization
E0135	DME code not requiring authorization
E0168	DME code not requiring authorization
E0182	DME code not requiring authorization
E0184	DME code not requiring authorization
E0235	DME code not requiring authorization
E0274	DME code not requiring authorization
E0305	DME code not requiring authorization
E0310	DME code not requiring authorization
E0424	DME code not requiring authorization

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DME codes not requiring authorization (partial list shown)HCPCS

E0130	DME code listed as not requiring authorization
E0135	DME code listed as not requiring authorization

Therapeutic and procedure codesCPT | HCPCS | mixed

99183	Hyperbaric Oxygen Therapy
C1300	Hyperbaric Oxygen Therapy HCPCS
64640	Nerve block / pain management code listed
63622	Listed as not requiring authorization for requests from orthopedic specialties
63688	Listed as not requiring authorization for requests from orthopedic specialties
95249	Ambulatory continuous glucose monitoring
31660	Bronchial thermoplasty
31661	Bronchial thermoplasty
58674	Radiofrequency ablation of uterine fibroids

Chiropractic codes requiring prior authorizationCPT | Revenue

98940	Chiropractic - manipulation of spine
98941	Chiropractic - manipulation
98942	Chiropractic - manipulation
98943	Chiropractic - manipulation
0940	Revenue code associated

Telehealth codes requiring authorizationCPT

G2010	Remote evaluation of recorded video and/or images
G2012	Brief communication technology-based service

Cardiac and pulmonary rehab codesCPT | HCPCSCovered

S9472	Cardiac rehabilitation service
93797	Cardiac rehab procedural code
93798	Cardiac rehab procedural code
G0422	Cardiac rehab, per session
G0423	Cardiac rehab, per session
G0237	Pulmonary rehab
G0238	Pulmonary rehab
G0239	Pulmonary rehab
G0424	Pulmonary rehab
S9473	Pulmonary rehab service

Enteral therapy and specialty drug J/C codes requiring authorization (examples)HCPCS | CPT | J/C

B4034-B4162	Enteral therapy HCPCS codes requiring authorization
C9054	Crosswalked injectable drug codes (various)
J0129	Abatacept (Orencia) and related J-codes
J0135	Adalimumab (Humira) and related J-codes
J0178	Aflibercept (Eylea) and related J-codes
J2505	Pegfilgrastim (Neulasta) and related J-codes

Enteral Therapy HCPCS CodesHCPCSCovered

B4034-B4162

HCPCS codes describing enteral formulas or disposable items requiring authorization

Listed J-codes and mappingsCPT|HCPCS|mixedCovered

J0599	listed (document mapping shows variants)
J2505	mapped to pegfilgrastim (Neulasta) and others per list
J2507	mapped entries
J2562	mapped entries
J2778	ranibizumab (Lucentis) mapping
J2783	rasburicase (Elitek) mapping
J2786	reslizumab (Cinqair) mapping
J2787	riboflavin ophth mapping
J2793	rilonacept (Aracalyst) mapping
J2796	romiplostim (Nplate) mapping

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OB ultrasounds without authorization (first 4)

RuleThe first 4 obstetric (OB) ultrasounds for a normal pregnancy can be performed without prior authorization.

ScopeApplies to routine/normal pregnancy ultrasounds as described in the imaging section of the policy.

ExceptionUltrasounds for high‑risk pregnancies (specified diagnosis codes) do not require authorization beyond this count.

Authorization triggerA fifth or subsequent OB ultrasound for a normal pregnancy requires prior authorization via radiology vendor (eviCore).

OB ultrasound count and authorization threshold (5+ require authorization)

ThresholdFirst 4 OB ultrasounds for a normal pregnancy are allowed without authorization.

When authorization requiredFive or more ultrasounds for a normal pregnancy require prior authorization.

Review vendorRadiology services and related authorizations are managed through eviCore Healthcare.

High‑risk pregnancy noteUltrasounds performed for high‑risk pregnancy diagnosis codes do not require authorization under the same limitation.

Therapy visit limits (60 visits per condition per plan year)

LimitRehabilitation and habilitation therapy benefits are limited to 60 visits per condition per plan year (applies to all therapies combined).

Combined therapiesThe 60‑visit limit applies to PT, OT, and ST combined for the specified condition within the plan year.

AuthorizationServices after the initial evaluation require authorization (initial evaluation itself does not require authorization).

ExclusionsLimit does not apply to therapies delivered in inpatient, ER, SNF, or observation settings (those settings are excluded from outpatient therapy authorization rules).

Provider Actions, Prior Authorization & Documentation

Prior Authorization

Sleep Study Authorization

Sleep studies (including home sleep studies) require prior authorization. Submit requests to Fidelis Care's prior authorization department; home sleep studies are not exempt from authorization.

Sleep studies and home sleep studies require prior authorization.

Prior Authorization

GI and Capsule Endoscopy Authorization

Gastroenterology procedures and wireless capsule endoscopy require authorization in specific places of service. If performed in POS 19 (off-campus outpatient hospital) or POS 22 (on-campus outpatient hospital) when an office or ambulatory surgery center is available, the listed GI CPT codes require authorization. Wireless capsule endoscopy and wireless motility capsule codes require authorization except when performed in POS 11 or 24.

GI CPT codes requiring authorization in POS 19 and 22 when office/ASC available: 43235, 43239, 43248, 45378, 45380, 45384, 45385, 46255, 46260, 46270.
Wireless capsule endoscopy/motility capsule: 91110, 91111, 91112 — authorization not required when performed in POS 11 or 24.

Prior Authorization

Outpatient Therapy Prior Authorization

Outpatient therapy (PT, OT, ST) requires prior authorization through National Imaging Associates (NIA) for all services after the initial evaluation. Initial evaluations do not require authorization, but any other billed therapy codes — even if provided on the same date as the initial evaluation — do require authorization. Non-therapy providers should request authorizations for post-evaluation therapy services directly through Fidelis Care.

Effective 10/1/2019, PT/OT/ST after the initial evaluation require authorization via NIA.
Initial PT/OT/ST evaluations are exempt from authorization but all other billed procedure codes require authorization.
Requests from non-therapy providers (MD/DO/DPM) for services after the initial evaluation should be submitted to Fidelis Care directly.

Prior Authorization

Telehealth Authorization

Telehealth brief communication services G2010 and G2012 require authorization prior to billing.

G2010 and G2012 require authorization.

Documentation Required

OMH Notification & Documentation Requirements

OMH-licensed inpatient mental health facilities for members under age 18 are not subject to authorization review for the first 14 days if the facility notifies Fidelis Care within two business days using the OMH Two-Day Notification and Initial Treatment Plan form. The facility must perform daily clinical review and participate in periodic consultation with Fidelis Care; services remain subject to retrospective review. Submit the OMH two-day notification form by fax to 718-896-1784 or email to Mental_Health_Admission@fideliscare.org.

Notify Fidelis Care of admission and initial treatment plan within two business days using OMH Two-Day Notification and Initial Treatment Plan form.
Fax: 718-896-1784 or email: Mental_Health_Admission@fideliscare.org.
Facilities must perform daily clinical review and participate in periodic consultation; services may be reviewed retrospectively.

Documentation Required

OASAS Notification and Discharge Documentation

OASAS-licensed inpatient SUD facilities in New York that participate in Fidelis Care's network are not subject to authorization review or concurrent utilization review for the first 28 days provided the facility notifies Fidelis Care of the admission and initial treatment plan within two business days. Use the OASAS Appendix A Notification Form and LOCADTR Medical Necessity Tool; fax or email submissions to 646-829-1421 or LOCADTR@fideliscare.org. Prior to discharge, provide a written discharge plan and indicate whether services in the plan are secured or reasonably available.

Notify Fidelis Care of admission and initial treatment plan within two business days using OASAS Appendix A Notification Form and LOCADTR tool.
Fax/email: 646-829-1421 or LOCADTR@fideliscare.org.
Provide written discharge plan prior to member discharge and indicate whether services are secured or reasonably available.

Documentation Required

Podiatry Documentation

Podiatric services for members with a confirmed diagnosis of Diabetes Mellitus do not require authorization; the diabetes diagnosis must be included on the claim. Podiatric services for non-diabetics continue to require authorization. All DME supplied in the podiatrist's office requires authorization regardless of diagnosis. Routine foot care for non-diabetics is not covered.

Include Diabetes Mellitus diagnosis on claim to avoid authorization for podiatry services.
Podiatry for non-diabetics requires prior authorization.
All DME supplied in-office by podiatrists requires authorization regardless of diagnosis.
Routine foot care for non-diabetics is non-covered.

Documentation Required

Required Documentation for Authorization

Authorization requests must include required documentation: specify HCPCS or J-code and the linked drug or enteral item when requesting prior authorization. Failure to indicate the code and associated drug/item may delay or cause denial of the request.

When requesting authorization for enteral therapy or J-code drugs, include the HCPCS or J-code and the specific drug/item/linked product on the request.
Incomplete documentation may delay or result in denial of authorization.

Step Therapy

Step Therapy / Oncology Drug Review Routing

Step therapy and oncology specialty drug reviews: oncology medications and supportive agents for members age 18+ in certain Fidelis product lines require prior authorization via New Century Health (NCH). Some oncology and specialty drug reviews are routed to NCH for utilization management and step therapy review; refer to the plan website or NCH portal for the list of drugs and step-therapy requirements.

Oncology medications/supportive agents for members 18+ in Medicaid Managed Care, Essential Plan, and certain QHPs require PA via New Century Health.
PA can be requested at my.newcenturyhealth.com or by calling 1-888-999-7713, option 1.
Certain requests (e.g., CAR T-cell therapy, Cablivi, immune globulins, sickle cell therapies, inpatient drugs, non-oncology uses) are reviewed directly by Fidelis and should NOT be sent to NCH.

Definitions and Reference Terms

LOCADTR clinical review tool referenced for SUD utilization review and discharge planning

ToolLOCADTR clinical review tool is referenced for SUD utilization review and discharge planning.

Use caseLOCADTR is used to qualify for the 28‑day concurrent review waiver and to perform utilization review after day 28 or at discharge.

DocumentationFacilities may fax/email OASAS Appendix A Notification Form and LOCADTR output to Fidelis Care as part of admission notification and discharge planning.

OMH Two-Day Notification and Initial Treatment Plan form

FormOMH Two-Day Notification and Initial Treatment Plan form must be completed and submitted to Fidelis Care (fax or email) within two business days of admission.

PurposeSubmission of the form notifies Fidelis Care of the admission and initial treatment plan to qualify for the 14‑day concurrent review waiver for OMH under‑18 admissions.

Contact methodsForm may be faxed (718-896-1784) or emailed to the Fidelis Care Mental Health Admissions address per policy instructions.

Initial evaluation (PT/OT/ST) definition — initial eval does not require authorization

DefinitionInitial evaluation for Physical Therapy (PT), Occupational Therapy (OT), or Speech Therapy (ST) does not require authorization.

Subsequent servicesAll other billed procedure codes performed after the initial evaluation require authorization through National Imaging Associates (NIA).

Same‑day billingEven if other billed procedure codes are performed on the same date as the initial evaluation, those codes require authorization.

Enteral therapy HCPCS codes range definition

HCPCS rangeEnteral therapy HCPCS codes referenced for authorization are B4034–B4162.

ScopeThis HCPCS range describes enteral formulas and disposable items that require prior authorization.

Authorization instructionWhen requesting authorization, document the specific HCPCS code(s) within B4034–B4162 to map to the required item/drug.

Level of Care Criteria

Inpatient (level of care criteria)

Inpatient: Facility must notify Fidelis Care within two business days using the OMH Two-Day Notification and Initial Treatment Plan form to qualify for the 14-day concurrent review waiver; facility must perform daily clinical review and participate in periodic consultation with Fidelis Care.2 business days

Services may be reviewed retrospectively after the waiver period.

Inpatient SUD (level of care criteria)

Inpatient SUD: Facility must notify Fidelis Care of admission and the initial treatment plan within two business days using the OASAS Appendix A Notification Form and LOCADTR tool to qualify for the 28-day concurrent review waiver; facility must perform daily clinical review and participate in periodic consultation. Services may be subject to utilization review after day 28 or upon discharge.2 business days

Out-of-state or out-of-network facilities remain subject to concurrent review throughout admission.

Treatment Modalities and Specific Criteria

ECT criteria

Outpatient ECT: Outpatient electroconvulsive therapy (CPT 90870) is listed under outpatient ECT and requires authorization in accordance with the behavioral health outpatient services authorization rules.

Applied Behavior Analysis (ABA) criteria

ABA authorization requirements: Authorization is required from Behavioral Health for Applied Behavior Analysis (ABA). Attestation of an ASD diagnosis by a licensed physician or psychologist must be provided at the time of request. Authorization is also required for DME speech generation equipment.

Referenced codes include H0035, 90899, S9480, H2013.

Counseling service criteria

Counseling services coverage: Members are allowed 10 hours (20 units) of counseling services in a continuous 12-month period. These services must be provided by certified providers and no longer require authorization; covered when billed with codes G0108 and G0109.10 hours / 20 units per 12 months

No authorization required for these counseling services.

Visit Limits and Utilization Thresholds

Home health skilled visits maximum per plan year

MaximumHome health skilled visits benefit maximum is 40 visits per plan year when skilled services are medically necessary.

DeterminationHome care approvals are based on medical need for skilled services; coverage up to the 40‑visit maximum applies per plan year.

Related benefitsHospice care coverage, when medically necessary, is available for up to 210 days per policy guidance.

Rehabilitation/Habilitation therapy visit limit (60 per condition per plan year)

LimitRehabilitation and habilitation therapy benefits are limited to 60 visits per condition per plan year (applies to all therapies combined).

Applies toIncludes PT, OT, and ST combined for the specified condition within the plan year.

Authorization noteServices performed after the initial evaluation require authorization; initial eval does not require authorization.

Counseling services (GO108, G0109) — 10 hours / 20 units in 12-month period without authorization

AllowanceCounseling services billed with codes G0108 and G0109 are allowed up to 10 hours (20 units) in a continuous 12‑month period without authorization.

Provider requirementServices must be provided by certified providers to be covered under this allowance.

Authorization statusThese counseling services no longer require prior authorization when billed with the specified codes within the allowed units/timeframe.

Background and Policy Context

This policy provides operational guidance to implement temporary utilization review and authorization exceptions introduced for New York State behavioral health and substance use disorder inpatient facilities during the COVID‑19 response. It clarifies when concurrent utilization review is waived for eligible OMH and OASAS licensed in‑state, in‑network facilities and specifies notification, daily clinical review, and periodic consultation requirements to qualify for those waivers. The document also consolidates authorization rules across service areas (inpatient admissions, outpatient procedures, imaging, DME, enteral therapy, and specialty drugs), and identifies documentation and submission expectations to avoid retrospective denials. Notably, some time‑limited waivers are described (for example, a 14‑day initial period for certain OMH under‑18 admissions and a 28‑day waiver for OASAS inpatient SUD), and exceptions to authorization requirements for pediatric oncology and ophthalmic indications are specified.

Policy Summary

PayerFidelis Care

PolicyCOVID-19 update and authorization/coding guidance

Policy CodePolicy N/A

Change TypeNo material change

Effective DateJan 1, 2020

Next Review DateN/A

Key ActionNotify Fidelis Care within two business days of OMH- or OASAS-licensed inpatient admissions using the specified notification form to qualify for the concurrent-review waiver period.

SourceLink

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