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Starting January 1, 2025, Fidelis Care will provide outpatient behavioral health benefits to NJ FamilyCare members. Learn more about the behavioral health benefit changes (PDF).

Are you pregnant? Download our FAQ to see if you qualify for FREE meals and support. Learn more about the MIM Program
Are you pregnant? Download our FAQ to see if you qualify for FREE meals and support. Learn more about the MIM Program

Behavioral Health Peer-to-Peer Process Change: Effective October 19, 2026

Effective October 19, 2026, Fidelis Care will align the behavioral health advisor review process with the existing physical health process. As part of this change, pre-determination peer-to-peer reviews will no longer be available for behavioral health authorization requests.

If an authorization request is denied, providers will follow the instructions in the denial letter to schedule a post-determination peer-to-peer review.

This process alignment is intended to streamline advisor workflows, support more timely completion of initial review requests, and enable facility/provider physicians to focus more fully on member care when a consultation is not required for service approval.

What Remains the Same

  • The overall medical necessity review process and notification timelines will not change.
  • Post-determination peer-to-peer opportunities will remain unchanged, consistent with NCQA expectations.

No immediate action is required. Please ensure your teams are aware of this change and prepared to follow the updated process beginning October 19, 2026.