Get Fidelis Physical Therapy Authorization
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How to fill out the Fidelis Physical Therapy Authorization online
Filling out the Fidelis Physical Therapy Authorization form online is a straightforward process that ensures you provide all necessary information for the approval of physical therapy services. This guide will walk you through each section of the form, highlighting the essential details required for a complete submission.
Follow the steps to successfully complete the authorization form.
- Use the ‘Get Form’ button to acquire the authorization form and open it for editing.
 - Complete the 'Fidelis Care Member Name' section by entering the last name, first name, and middle initial of the member. Ensure this information is accurate for proper identification.
 - Provide the 'Fidelis Care Member ID #' which can be found on the member's card. This ID is essential for processing your request.
 - Fill in the 'ICD-9 Diagnosis Code(s)' section. Include the relevant diagnosis codes that correspond to the patient's condition requiring therapy.
 - In the 'Services' section, list the 'CPT/Procedure Code(s) and Description' of the services requested. Ensure each service is clearly described and its code correctly entered.
 - Enter the date of birth in the format mm/dd/yyyy for the patient. This helps confirm the patient's identity and eligibility.
 - Check any applicable boxes under the options including Medicare, No-Fault, or Workers' Comp, if relevant to the patient's situation.
 - Input the 'Date of Injury' and 'Date of Procedure,' if applicable, using the mm/dd/yyyy format.
 - Provide the 'Provider Name' and their contact information, including phone number and fax number, as well as the Tax ID or NPI number.
 - Complete any additional sections that are relevant, including indicating if the request is urgent or the type of facility involved.
 - Attach any required clinical information as listed to support the request, ensuring you circle what is included before submission.
 - After completing all sections thoroughly and checking for accuracy, save your changes. Then, proceed to download, print, or share the completed form as necessary.
 
Start your application process now by completing and submitting the Fidelis Physical Therapy Authorization online.
Yes, Fidelis Medicaid typically covers physical therapy as part of its comprehensive healthcare benefits. If you've been prescribed therapy for recovery or rehabilitation, you can access these services under your Fidelis Medicaid plan. It's essential to verify your specific coverage details and obtain appropriate prior authorization for a smooth process. By leveraging the Fidelis Physical Therapy Authorization, you can ensure that you maximize your eligible benefits.
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