Record Requests/Lien Inquiries

Do I need to include a notarized HIPAA authorization form?

Record requests made by record retrieval companies (for example, Record Access, Keais, etc.) on behalf of a member require a notarized HIPAA authorization form. If an attorney is making the request in order to obtain lien information or as part of a personal injury claim, this also requires a notarized HIPAA authorization form. Fidelis Care requires the authorization form to be notarized in order to protect our member’s privacy.

Record requests made by anyone advocating for the member (for example, a family member, Legal Aid, or Ombudsman, etc.) do not need to be notarized. Such record requests must still include a signed HIPAA authorization form.

Do I need an original HIPAA authorization form to complete a request for records?

No. A copy is acceptable as long as it is compliant, legible, and notarized (when necessary).

What happens if my HIPAA authorization form is not compliant or notarized?

Fidelis Care will not process the request and will notify you in writing indicating the reason your request could not be processed. If a member contacts Fidelis Care and informs Fidelis Care’s Member Services Department that (1) the records are not being sought in connection with a lien or personal injury case, or (2) it would be a hardship to obtain a notarization, then Fidelis Care will not request that the HIPAA form be notarized.

Can I follow up on my request via email, phone or fax?

Members may contact Fidelis Care’s Member Services Department.

Follow-up requests made by record retrieval companies or attorneys for the purpose of obtaining lien information MUST be sent in writing to:

Fidelis Care
PGD – 38th Floor
25-01 Jackson Avenue
Long Island City, NY 11101

Does Fidelis Care provide medical records? If not, who do I contact for medical records?

Fidelis Care is a health insurance company and does not generally have medical records. Please contact the health care provider that rendered the services for medical records.

How long should I wait before following up on a request?

The entire process can take up to 30 days to process. If you have not received your records within this time frame, please follow up in writing via U.S. Postal Service (USPS) or overnight courier. Please include a self-addressed stamped envelope in order to permit Fidelis Care to respond.

Is Fidelis Care part of an ERISA plan?

No.

If a member receives Medicaid through Fidelis Care, and Fidelis Care is not asserting a lien, does that mean that Medicaid will also not assert a lien?

Fidelis Care can only waive its own lien.

Please be advised that Fidelis Care cannot waive liens on behalf of any government program such as Medicaid or Medicare.

If the inquiry concerns a New York State (hereinafter, the “State”) Medicaid recipient, please note that the State contracts with Health Management Systems, Inc. (HMS) to handle Medicaid casualty recoveries for New York State Department of Health (SDOH) Medicaid recipients with personal injury lawsuits. Most county Medicaid programs also contract with HMS for this recovery work.

As such, attorneys inquiring about personal injury lawsuits for Medicaid recipients should directly contact HMS or SDOH Third Party Liability (TPL) at the phone numbers below:

• HMS: 1-877-331-1460
• SDOH TPL: 518-473-5330

Will Fidelis Care assert a lien for personal injury cases of Medicaid Managed Care members?

Fidelis Care does not assert liens for the personal injury cases of Medicaid Managed Care members, but documentation proving it is a personal injury matter must be provided to Fidelis Care in order to receive a lien waiver letter. Fidelis Care may assert a lien for personal injury cases of Medicare and commercial members.

Will Fidelis Care assert a lien if my case involves no-fault injury?

Yes. Fidelis Care asserts liens against no-fault and/or other third-party health insurance claims through Fidelis Care's outside vendors. Inquiries should be directed to The Rawlings Company by:

1) Phone

• Medicaid 855-967-6619
• Medicare Advantage 888-285-1276

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2) Email

• CenteneReferrals@rawlingscompany.com

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3) Mail

The Rawlings Company
P.O. Box 2000
LaGrange, KY 40031

What documentation do I need to submit for a lien waiver?

If Fidelis Care does not assert a lien, Fidelis Care will accept any one of the following documents in order to provide a lien waiver for a personal injury case:

• Summons and Complaint
• Bill of Particulars
• Claim acknowledgement form from an insurance carrier, provided the type of policy is described
• A letter from a third-party insurance carrier if the type of policy is described
• Executed retainer agreement (the type of accident must be mentioned in the agreement)
• Executed settlement agreement 

Where can correspondence regarding liens and/or subrogation be sent?

All correspondence regarding liens and/or subrogation must be sent to The Rawlings Company by:

How long will it take to receive a response after requesting insurance records?

Fidelis Care responds to inquiries for the release of insurance records in the order in which they are received. Due to the large number of requests received, a response may take up to approximately 30 calendar days from the date Fidelis Care receives the request. An expedited response may be warranted if a court date is pending. In such case, a copy of the underlying scheduling order must be submitted with the request.

Can I fax/email my initial insurance record request and follow-up inquiries to Fidelis Care?

No. Fidelis Care does not respond to inquiries received via fax, email or phone. All requests for insurance records must be mailed to:

Fidelis Care
PGD – 38th Floor
25-01 Jackson Avenue
Long Island City, NY 11101

Is there a specific authorization form that must accompany my request?

No. Fidelis Care will accept any authorization form, as long as it is HIPAA compliant.

Do I need to include a HIPAA authorization form?

Yes, for all Record Requests to send records to a third party. For example, requests made by a law firm, attorney, or representative require a HIPAA authorization form. Download a copy of a standard HIPAA form.

Why does Fidelis Care request that the HIPAA authorization form be notarized?

Fidelis Care imposes this requirement with regard to record retrieval companies and requests by attorneys relating to lien inquiries or personal injury actions in order to protect our member’s privacy. This requirement also ensures that attorneys who do not have authority to act on behalf of a member in connection with a personal injury case or lien are not seeking medical records on a member’s behalf inappropriately.