Fidelis Care Pre-Screen Application

Provider Portal Sign-Up as a Billing Company

Access is granted by Tax ID. Only complete one application per Tax ID.

You must enter your Tax ID:

Tax ID:

You must enter your NPI number:

NPI Number *:

* Your NPI number must be on file with Fidelis Care. If it was not submitted to Fidelis, you will be required to use your Fidelis Care Provider ID. In order to submit your NPI number to Fidelis Care, please follow the link below.

https://secure.fideliscare.org/npi/

You must agree to the following:

You are representing that you have the authority to enable and control access for other users at your organization, i.e. you are in a position to serve as a "Main Office Contact".*

Your access will be compliant with HIPAA laws, rules and regulations.

Once access is secured, you will only have access to claims data associated with the Tax Identification Number (TIN) specified in your access request.

You agree to submit a HIPAA Business Associate Agreement that represents that you have the authority to view claims information for the represented health care provider organization. Please fax the HIPAA Business Associate Agreement to Fidelis Care at 518-445-3995, Attention Provider Relations.

*If you should not be the Main Office Contact for your organization, a current Main Office Contact at your organization may enable you as a user. If a Main Office Contact does not exist for your organization, one must be created through this process.