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:
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.