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HomeProvidersProvider ResourcesAuthorization Grids

Authorization Grids

View Authorization Grids available for Medicare, Medicaid, Child Health Plus, and Qualified Health Plans (Metal-Level Products). 

Medicaid, Child Health Plus, and HealthierLife (HARP)

Medicaid Authorization Look Up Tool

2024

Authorization Grid Detail, Effective December 1, 2024 (PDF)

Authorization Grid Detail, Effective November 1, 2024 (PDF)

Authorization Grid Detail, Effective October 1, 2024 (PDF)

Authorization Grid Detail, Effective August 1, 2024 (PDF)

Authorization Grid Detail, Effective July 1, 2024 (PDF)

Authorization Grid Detail, Effective June 1, 2024 (PDF)

Authorization Grid Detail, Effective May 1, 2024 (PDF)

Authorization Grid Detail, Effective April 1, 2024 (PDF)

Authorization Grid Detail, Effective March 1, 2024 (PDF)

Authorization Grid Detail, Effective February 1, 2024 (PDF)

Authorization Grid Detail, Effective January 1, 2024 (PDF)

2023  

Authorization Grid Detail, Effective December 1, 2023 (PDF)

Authorization Grid Detail, Effective November 1, 2023 (PDF)

Authorization Grid Detail, Effective October 1, 2023 (PDF)

Authorization Grid Detail, Effective September 1, 2023 (PDF)

Authorization Grid Detail, Effective August 1, 2023 (PDF)

Authorization Grid Detail, Effective July 1, 2023 (PDF)

Authorization Grid Detail, Effective June 1, 2023 (PDF)

Authorization Grid Detail, Effective May 1, 2023 (PDF)

Authorization Grid Detail, Effective April 1, 2023 (PDF)

Authorization Grid Detail, Effective March 1, 2023 (PDF)

Authorization Grid Detail, Effective February 1, 2023 (PDF)

Authorization Grid Detail, Effective January 1, 2023 (PDF)

2022  

Authorization Grid Detail, Effective December 1, 2022 (PDF)

Authorization Grid Detail, Effective November 1, 2022 (PDF)

Authorization Grid Detail, Effective October 1, 2022 (PDF)

Authorization Grid Detail, Effective August 1, 2022 (PDF)

Authorization Grid Detail, Effective July 1, 2022 (PDF)

Authorization Grid Detail, Effective June 1, 2022 (PDF)

Authorization Grid Detail, Effective May 1, 2022 (PDF)

Authorization Grid Detail, Effective April 1, 2022 (PDF)

Authorization Grid Detail, Effective March 1, 2022 (PDF)

Authorization Grid Detail, Effective February 1, 2022 (PDF)

Authorization Grid Detail, Effective January 1, 2022 (PDF)

2021  

Authorization Grid Detail, Effective December 1, 2021 (PDF)

Authorization Grid Detail, Effective October 1, 2021 (PDF)

Authorization Grid Detail, Effective September 1, 2021 (PDF)

Authorization Grid Detail, Effective August 1, 2021 (PDF)

Authorization Grid Detail, Effective July 1, 2021 (PDF)

Authorization Grid Detail, Effective June 1, 2021 (PDF)

Authorization Grid Detail, Effective April 1, 2021 (PDF)

Authorization Grid Detail, Effective February 1, 2021 (PDF)

Authorization Grid Detail, Effective January 1, 2021 (PDF)

2020

Authorization Grid Detail, Effective December 1, 2020 (PDF)

Authorization Grid Detail, Effective November 1, 2020 (PDF)

Authorization Grid Detail, Effective October 1, 2020 (PDF)

Authorization Grid Detail, Effective August 1, 2020 (PDF)

Authorization Grid Detail, Effective July 1, 2020 (PDF)

Authorization Grid Detail, Effective May 1, 2020 (PDF)

Authorization Grid Detail, Effective April 1, 2020 (PDF)

Authorization Grid Detail, Effective February 1, 2020 (PDF)

Authorization Grid Detail, Effective January 1, 2020 (PDF)

Medicare

Medicare Authorization Look Up Tool 

2024

Authorization Grid Detail, Effective December 1, 2024 (PDF)

Authorization Grid Detail, Effective November 1, 2024 (PDF)

Authorization Grid Detail, Effective October 1, 2024 (PDF)

Authorization Grid Detail, Effective August 1, 2024 (PDF)

Authorization Grid Detail, Effective July 1, 2024 (PDF)

Authorization Grid Detail, Effective June 1, 2024 (PDF)

Authorization Grid Detail, Effective May 1, 2024 (PDF)

Authorization Grid Detail, Effective April 1, 2024 (PDF)

Authorization Grid Detail, Effective March 1, 2024 (PDF)

Authorization Grid Detail, Effective February 1, 2024 (PDF)

Authorization Grid Detail, Effective January 1, 2024 (PDF)

2023

Authorization Grid Detail, Effective December 1, 2023 (PDF)

Authorization Grid Detail, Effective November 1, 2023 (PDF)

Authorization Grid Detail, Effective October 1, 2023 (PDF)

Authorization Grid Detail, Effective September 1, 2023 (PDF)

Authorization Grid Detail, Effective August 1, 2023 (PDF)

Authorization Grid Detail, Effective July 1, 2023 (PDF)

Authorization Grid Detail, Effective June 1, 2023 (PDF)

Authorization Grid Detail, Effective May 1, 2023 (PDF)

Authorization Grid Detail, Effective April 1, 2023 (PDF)

Authorization Grid Detail, Effective March 1, 2023 (PDF)

Authorization Grid Detail, Effective February 1, 2023 (PDF)

Authorization Grid Detail, Effective January 1, 2023 (PDF)

2022

Authorization Grid Detail, Effective December 1, 2022 (PDF)

Authorization Grid Detail, Effective November 1, 2022 (PDF)

Authorization Grid Detail, Effective October 1, 2022 (PDF)

Authorization Grid Detail, Effective August 1, 2022 (PDF)

Authorization Grid Detail, Effective July 1, 2022 (PDF)

Authorization Grid Detail, Effective May 1, 2022 (PDF)

Authorization Grid Detail, Effective March 1, 2022 (PDF)

Authorization Grid Detail, Effective January 1, 2022 (PDF)

2021

Authorization Grid Detail, Effective December 1, 2021 (PDF)

Authorization Grid Detail, Effective November 1, 2021 (PDF)

Authorization Grid Detail, Effective October 1, 2021 (PDF)

Authorization Grid Detail, Effective September 1, 2021 (PDF)

Authorization Grid Detail, Effective August 1, 2021 (PDF)

Authorization Grid Detail, Effective July 1, 2021 (PDF)

Authorization Grid Detail, Effective June 1, 2021 (PDF)

Authorization Grid Detail, Effective April 1, 2021 (PDF)

Authorization Grid Detail, Effective February 1, 2021 (PDF)

Authorization Grid Detail, Effective January 1, 2021 (PDF)

2020

Authorization Grid Detail, Effective December 1, 2020 (PDF)

Authorization Grid Detail, Effective November 1, 2020 (PDF)

Authorization Grid Detail, Effective October 1, 2020 (PDF)

Authorization Grid Detail, Effective July 1, 2020 (PDF)

Authorization Grid Detail, Effective May 1, 2020 (PDF)

Authorization Grid Detail, Effective April 1, 2020 (PDF)

Authorization Grid Detail, Effective February 1, 2020 (PDF)

Authorization Grid Detail, Effective January 1, 2020 (PDF) 

Qualified Health Plans (Metal-Level Products)

Qualified Health Plans (Metal-Level Products) Authorization Look Up Tool

2024

Authorization Grid Detail, Effective December 1, 2024 (PDF)

Authorization Grid Detail, Effective November 1, 2024 (PDF)

Authorization Grid Detail, Effective October 1, 2024 (PDF)

Authorization Grid Detail, Effective August 1, 2024 (PDF)

Authorization Grid Detail, Effective July 1, 2024 (PDF)

Authorization Grid Detail, Effective June 1, 2024 (PDF)

Authorization Grid Detail, Effective May 1, 2024 (PDF)

Authorization Grid Detail, Effective April 1, 2024 (PDF)

Authorization Grid Detail, Effective March 1, 2024 (PDF)

Authorization Grid Detail, Effective February 1, 2024 (PDF)

Authorization Grid Detail, Effective January  1, 2024 (PDF)

2023

Authorization Grid Detail, Effective December 1, 2023 (PDF)

Authorization Grid Detail, Effective November 1, 2023 (PDF)

Authorization Grid Detail, Effective October 1, 2023 (PDF)

Authorization Grid Detail, Effective September 1, 2023 (PDF)

Authorization Grid Detail, Effective August 1, 2023 (PDF)

Authorization Grid Detail, Effective July 1, 2023 (PDF)

Authorization Grid Detail, Effective June 1, 2023 (PDF)

Authorization Grid Detail, Effective May 1, 2023 (PDF)

Authorization Grid Detail, Effective April 1, 2023 (PDF)

Authorization Grid Detail, Effective February 1, 2023 (PDF)

Authorization Grid Detail, Effective January 1, 2023 (PDF)

2022

Authorization Grid Detail, Effective December 1, 2022 (PDF)

Authorization Grid Detail, Effective November 1, 2022 (PDF)

Authorization Grid Detail, Effective October 1, 2022 (PDF)

Authorization Grid Detail, Effective August 1, 2022 (PDF)

Authorization Grid Detail, Effective June 1, 2022 (PDF)

Authorization Grid Detail, Effective May 1, 2022 (PDF)

Authorization Grid Detail, Effective April 1, 2022 (PDF)

Authorization Grid Detail, Effective March 1, 2022 (PDF)

Authorization Grid Detail, Effective January 1, 2022 (PDF)

2021

Authorization Grid Detail, Effective December 1, 2021 (PDF)

Authorization Grid Detail, Effective October 1, 2021 (PDF)

Authorization Grid Detail, Effective September 1, 2021 (PDF)

Authorization Grid Detail, Effective August 1, 2021 (PDF)

Authorization Grid Detail, Effective July 1, 2021 (PDF)

Authorization Grid Detail, Effective June 1, 2021 (PDF)

Authorization Grid Detail, Effective April 1, 2021 (PDF)

Authorization Grid Detail, Effective February 1, 2021 (PDF)

Authorization Grid Detail, Effective January 1, 2021 (PDF)

2020

Authorization Grid Detail, Effective December 1, 2020 (PDF)

Authorization Grid Detail, Effective November 1, 2020 (PDF)

Authorization Grid Detail, Effective October 1, 2020 (PDF)

Authorization Grid Detail, Effective August 1, 2020 (PDF)

Authorization Grid Detail, Effective July 1, 2020 (PDF)

Authorization Grid Detail, Effective May 1, 2020 (PDF)

Authorization Grid Detail, Effective April 1, 2020 (PDF)

Authorization Grid Detail, Effective February 1, 2020 (PDF)

Authorization Grid Detail, Effective January 1, 2020 (PDF) 

Essential Plan

Essential Plan Authorization Look Up Tool

2024

Authorization Grid Detail, Effective December 1, 2024 (PDF)

Authorization Grid Detail, Effective November 1, 2024 (PDF)

Authorization Grid Detail, Effective October 1, 2024 (PDF)

Authorization Grid Detail, Effective August 1, 2024 (PDF)

Authorization Grid Detail, Effective July 1, 2024 (PDF)

Authorization Grid Detail, Effective June 1, 2024 (PDF)

Authorization Grid Detail, Effective May 1, 2024 (PDF)

Authorization Grid Detail, Effective April 1, 2024 (PDF)

Authorization Grid Detail, Effective March 1, 2024 (PDF)

Authorization Grid Detail, Effective February 1, 2024 (PDF)

Authorization Grid Detail, Effective January  1, 2024 (PDF)

2023

Authorization Grid Detail, Effective December 1, 2023 (PDF)

Authorization Grid Detail, Effective November 1, 2023 (PDF)

Authorization Grid Detail, Effective October 1, 2023 (PDF)

Authorization Grid Detail, Effective September 1, 2023 (PDF)

Authorization Grid Detail, Effective August 1, 2023 (PDF)

Authorization Grid Detail, Effective July 1, 2023 (PDF)

Authorization Grid Detail, Effective June 1, 2023 (PDF)

Authorization Grid Detail, Effective May 1, 2023 (PDF)

Authorization Grid Detail, Effective April 1, 2023 (PDF)

Authorization Grid Detail, Effective February 1, 2023 (PDF)

Authorization Grid Detail, Effective January 1, 2023 (PDF)

2022

Authorization Grid Detail, Effective December 1, 2022 (PDF)

Authorization Grid Detail, Effective November 1, 2022 (PDF)

Authorization Grid Detail, Effective October 1, 2022 (PDF)

Authorization Grid Detail, Effective August 1, 2022 (PDF)

Authorization Grid Detail, Effective July 1, 2022 (PDF)

Authorization Grid Detail, Effective June 1, 2022 (PDF)

Authorization Grid Detail, Effective May 1, 2022 (PDF)

Authorization Grid Detail, Effective April 1, 2022 (PDF)

Authorization Grid Detail, Effective March 1, 2022 (PDF)

Authorization Grid Detail, Effective January 1, 2022 (PDF)

2021

Authorization Grid Detail, Effective December 1, 2021 (PDF)

Authorization Grid Detail, Effective October 1, 2021 (PDF)

Authorization Grid Detail, Effective September 1, 2021 (PDF)

Authorization Grid Detail, Effective August 1, 2021 (PDF)

Authorization Grid Detail, Effective July 1, 2021 (PDF)

Authorization Grid Detail, Effective June 1, 2021 (PDF)

Authorization Grid Detail, Effective April 1, 2021 (PDF)

Authorization Grid Detail, Effective February 1, 2021 (PDF)

Authorization Grid Detail, Effective January 1, 2021 (PDF)

2020

Authorization Grid Detail, Effective December 1, 2020 (PDF)

Authorization Grid Detail, Effective November 1, 2020 (PDF)

Authorization Grid Detail, Effective October 1, 2020 (PDF)

Authorization Grid Detail, Effective August 1, 2020 (PDF)

Authorization Grid Detail, Effective July 1, 2020 (PDF)

Authorization Grid Detail, Effective May 1, 2020 (PDF)

Authorization Grid Detail, Effective April 1, 2020 (PDF)

Authorization Grid Detail, Effective February 1, 2020 (PDF)

Authorization Grid Detail, Effective January 1, 2020 (PDF)

Pharmacy - Electronic Prior Authorizations

Fidelis Care has made submitting Pharmacy electronic prior authorizations (ePA) easier and more convenient. ePA is Fidelis Care's preferred method to receive prior authorizations. 

We have partnered with ePA vendors, CoverMyMeds and Surescripts, making it easy for you to submit and access electronic prior authorizations via the ePA vendor of your choice. For more information on how to get started and to sign up, view Electronic Prior Authorizations

 

Provider Access Online

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Manuals, Forms and Policies

Provider manuals, tip sheets, important forms, and applications.
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Pharmacy Services

Formularies, utilization management programs, and specialty drug programs.

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Utilization Management (UM)

Find information and links to external vendor authorization programs as well as links to internal Fidelis Care prior authorization resources.

UM Resources