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  • St Pt Or Ot Treatment Request Form Fidelis

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ST, PT or OT Treatment Request Form Submission of request form required for: NYS of Health, Managed Medicaid, CHP, FHP and Medicare Advantage Speech Therapy Fax: (800) 8608720 Physical Therapy Occupational.

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Effective October 1, 2019, physical medicine services (physical therapy, occupational therapy and speech therapy) will require Prior Authorization for all services provided to all Fidelis Care members except for those in the Medicare Advantage (MA), Medicaid Advantage Plus (MAP), and Dual Advantage (DUAL) products.

Imaging (CT/PET scans, MRIs) $40 copay per visit after deductible Not covered Prior authorization is required for certain blood work and diagnostic imaging except x-ray.

Covered benefits include: Preventive care, including well visits, immunizations, and preventive screenings. Dental and vision care. Prescription and non-prescription drugs.

Call Member Services at 1-888-FIDELIS (1-888-343-3547). We're here to help.

Most people will drive to an office or facility to complete their therapy sessions but some people may not have the means to get out of the house. In these cases, home therapy may be covered by Medicare or Medicaid. The first requirement is that you be homebound to receive home health services.

Medicaid will pay for up to 40 physical therapy visits, 20 occupational therapy visits, and 20 speech therapy visits per enrollee in a twelve-month benefit year.

Qualified Health Plan members and their spouses are eligible for Fitness Reimbursements, which pay you and a covered spouse up to $600 per year when you enroll in a qualified fitness facility and each visit at least 50 times in a six-month period.

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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