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Fidel is Secretive Medicare Medicaid Plan (MMP) AUTHORIZATION/RECERTIFICATION FORM * FAX completed AUTHORIZATION/RECERTIFICATION FORM to 18665961054 * Phone number: 18442397387 * Please submit supporting
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How to fill out fidelis securecare - authorizationpre-certification
How to fill out Fidelis SecureCare - Authorization/Pre-Certification:
01
Obtain the Authorization/Pre-Certification form from Fidelis SecureCare or download it from their website.
02
Fill out the patient's personal information accurately, including their name, address, phone number, and date of birth.
03
Provide the patient's insurance information, including the identification number and group number.
04
Indicate the name and contact information of the referring physician who is requesting the authorization/pre-certification.
05
Select the type of service or procedure that requires authorization/pre-certification from the provided list.
06
Provide the details of the service or procedure, including the date it is scheduled for and any additional information requested by Fidelis SecureCare.
07
Attach any relevant supporting documentation, such as medical records, test results, or discharge summaries.
08
Review the completed form for accuracy and sign it.
09
Submit the authorization/pre-certification form to Fidelis SecureCare through the designated submission channel, which could be fax, email, or an online portal.
Who needs Fidelis SecureCare - Authorization/Pre-Certification?
01
Patients who have health insurance coverage provided by Fidelis SecureCare.
02
Patients whose healthcare provider has recommended a service or procedure that requires prior authorization or pre-certification.
03
Patients who want to ensure that their health insurance will cover the cost of a particular service or procedure before they receive it.
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What is fidelis securecare - authorizationpre-certification?
Fidelis SecureCare - Authorization Pre-certification is a process in which healthcare providers obtain approval from the insurance company prior to performing certain medical procedures or services.
Who is required to file fidelis securecare - authorizationpre-certification?
Healthcare providers are required to file Fidelis SecureCare - Authorization Pre-certification.
How to fill out fidelis securecare - authorizationpre-certification?
To fill out Fidelis SecureCare - Authorization Pre-certification, healthcare providers must provide patient information, medical procedure details, and justification for the requested services.
What is the purpose of fidelis securecare - authorizationpre-certification?
The purpose of Fidelis SecureCare - Authorization Pre-certification is to ensure that the requested medical procedures or services are necessary and will be covered by the insurance company.
What information must be reported on fidelis securecare - authorizationpre-certification?
Information such as patient demographics, diagnosis codes, procedure codes, and supporting documentation must be reported on Fidelis SecureCare - Authorization Pre-certification.
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