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  • Fidelis Care Ot Pt Treatment Form

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Speech, Physical, or Occupational Therapy Treatment Request Form Applicable products: Managed Medicaid, Child Health Plus (CHP), Family Health Plus (FHP), Medicare Advantage, Required for: Managed.

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Regional offices are located in New York City, Albany, Syracuse, Rochester, and Buffalo. More than 20 community offices throughout the State enable Fidelis Care to serve local members or those who have questions about health insurance for themselves or their families.

Fidelis Care, a leading health insurer that serves all of New York State, offers free or low-cost comprehensive health coverage, including Medicaid Managed Care, Medicare Advantage, Child Health Plus, and plans available through NY State of Health, The Official Health Plan Marketplace.

Fidelis Care, a leading health insurer that serves all of New York State, offers free or low-cost comprehensive health coverage, including Medicaid Managed Care, Medicare Advantage, Child Health Plus, and plans available through NY State of Health, The Official Health Plan Marketplace.

IMPORTANT – Corrected claims and claim appeals must be submitted within 60 (sixty) days from the claims remittance.

Following the implementation of the Patient Protection and Affordable Care Act (ACA), Fidelis Care made the decision to offer products covering the Essential Health Benefits as required by the ACA and the New York State health care exchange, known as the New York State of Health (NYSOH).

Must be submitted via the appropriate fax line or by phone at 1-888-FIDELIS (1-888-343-3547): Urgent Requests.

Fidelis Care offers free online claims submission through Ability's claims portal. To learn more about Ability, call 1-888-499-5465 or visit .mdon-line.com/fideliscare. You also have the option to contact another clearinghouse to initiate 837-claim submission to Fidelis Care.

Fidelis Care does require authorization of post stabilization services and inpatient admissions, after emergency room services are completed. All facility admissions are reviewed for medical necessity.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232