Fidelis Care Medicaid, CHP, and HARP Authorization Grid — July 2026: Requirements & Documentation

Direct answer

Fidelis Care's Medicaid, CHP, and HARP Authorization Grid — July 2026 contains 60 current, production-approved prior authorization rules backed by 228 source citations in the QuickIntell policy database. It applies to Medicaid Managed Care, Child Health Plus, HealthierLife HARP in New York. Confirm the member's exact plan, requested service or drug, code, and date of service against the official payer source before submitting an authorization.

Policy applicability

Effective date: July 1, 2026
Policy version: Database document v1, effective 2026-07-01
Structured rules: 60
Source citations: 228
Product lines: Medicaid Managed Care, Child Health Plus, HealthierLife HARP
Geography: New York
Plans: See official policy for plan-level applicability
Service category: Prior authorization
Service: Medicaid, CHP, and HARP Authorization Grid — July 2026

Code inventory

This source is associated with 346 CPT or HCPCS codes. The preview shows up to 50 code numbers for operational lookup; confirm the current code definition and policy applicability before submitting an authorization or claim.

HCPCS H0038CPT 10060CPT 11043CPT 11100CPT 11730CPT 15011CPT 15012CPT 15736CPT 15738CPT 17000CPT 19303CPT 19350CPT 19364CPT 20600CPT 20605CPT 20932CPT 20933CPT 20934CPT 22830CPT 22867CPT 22868CPT 22869CPT 22870CPT 23140

Check this document's code inventory

Search the 346 codes associated with this source. Do not enter patient information.

Operational verification before action

Before using this Fidelis Care reference for an authorization, claim, or appeal, match the member's exact product, state, network, and date of service to the official policy. Confirm that the displayed date basis and source version still control the case. If the payer portal, member benefit document, or current policy conflicts with this summary, follow the controlling payer source and retain the verification result in the account record.

For authorization work, record the submission channel, reference number, representative or portal response, and any stated follow-up deadline. For denials, preserve the remittance detail, denial notice, original submission evidence, and the version of the policy used for correction or appeal.

Documentation checklist

Verify member eligibility, benefit plan, network status, and date-of-service applicability.
Match the requested CPT or HCPCS code to the current official source and confirm any code-specific notes.
Collect the ordering clinician's records and every document requested by the matched payer rule.
Confirm the servicing provider, facility, place of service, and applicable state or plan requirements.
Record the authorization decision, reference number, approved units, and validity dates before claim submission.

Submission notes

This page summarizes 60 active prior authorization rules from one payer-owned source document.
Use the official payer portal or submission channel shown in the source; routes can differ by plan and service.
Recheck the source when the member, plan, code, site of care, or date of service changes.

Common denial risks

Using a rule from the wrong product, state, network, or date-of-service period.
Submitting an incomplete clinical packet or omitting a code-specific requirement.
Starting service before the authorization is approved or outside the approved validity window.
Billing a code, unit count, provider, or site of care that differs from the authorization record.

Database provenance

This page was generated from 60 active prior authorization rules and 228 source citations. The source database marks these rules as approved production and public eligible.

Correction or appeal path

If the payer response conflicts with the current source, preserve the submission record, compare the cited policy version and applicable rule, correct missing information, and request payer reconsideration or appeal through the plan-specific channel.

Official policy source

This operational summary is based on Authorization Grid Detail, Effective July 1, 2026, version Database document v1, effective 2026-07-01. Payer requirements can vary by member, plan, state, network, and date of service.

Review the official policy source

Related QuickIntell resources

Fidelis Care payer guide →Prior authorization guides →Denial code reference →Automate prior authorization with QuickAuth →Prevent and resolve denials with QuickRCM →

Disclaimer

This page is operational reference for medical-billing professionals. It is not legal, clinical, or contractual advice. Payer policies change without notice — always verify against Fidelis Care's current published documents before submission. CPT® is a registered trademark of the American Medical Association.