| Department | Previous Fax Number | New Fax Number | Type of Faxes |
| Behavioral Health Authorization Requests | 718-896-1784 | 833-561-0094 | Behavioral Health Authorization Requests (Excluding Substance Abuse) |
| Behavioral Health Children's Authorization | 347-690-7362 | 833-663-1604 | All Children's Behavioral Health Authorizations
and Plans of Care (POC) |
| Behavioral Health Court Orders | 877-584-9642 | 877-584-9642 | All Court Orders for Behavioral Health |
| Behavioral Health HARP Authorization | 347-868-6427 | 833-561-0089 | All HARP Behavioral Health Authorizations |
| Claims | 877-247-9187 | 877-247-9187 | Claims Invoices |
| Credentialing | 716-636-2522 | 833-710-1981 | Initial Credentialing Application/Provider Data Form (Participating Contract/TIN Required) Re-credentialing Application/Information |
| Government Affairs & Compliance | 718-362-1271 | 833-710-1655 | Independent Dispute Resolution Entity (IDRE) Inquiries |
| Government Affairs & Compliance | 315-849-3885 | 833-710-1972 | Non-Discrimination Inquiries |
| Medical Appeals | 718-393-6779 | 833-710-2226 | Pre-Service Medical Appeals for all Non Long Term Care Members |
| Member Services | 718-393-6635 | 833-710-2220 | PCP Change Request Forms |
| Member Services | 877-533-2402 | 877-533-2403 | Health Care Proxy (Medicare)
Letter Log (Medicare and Medicaid)
Medicare Disenrollment
Pharmacy Faxes
Medicare Bills |
| Member Services | 718-897-1988 | 833-710-1775 | Baby Care Incentives
Children and Adult Medical Records
Health Care Proxy (Medicare)
Medicaid Letter Log (Legal)
MLTC Letter Log
W-9 Forms & Provider
Bills and Claims
Coverage of Benefits and Terminations
Health Care Proxy Medicaid
Pharmacy Reimbursements
Authorizations Requests
Summary of Doctor’s Appointment
Transportation Documents |
| Member Services | 716-564-6250 | 833-710-1777 | Transportation Authorizations for Non-Emergency Transportation |
| Member Services | 718-896-6832 | 833-710-1776 | Letter Log (Medicare and Medicaid)
Medicare HIPAA Letter
NYSARC Forms
Personal Care Services Faxes (Physician’s Order for Personal Care/Consumer Directed Personal Assistance)
Pharmacy Faxes
W-9 Providers/ Home Health Agency
Coordination of Benefits (COB)
Medicaid HIPAA Forms |
| MLTC | 716-803-8727 | 833-710-1772 | MLTC Authorization Requests, Clinical Information and Notifications |
| MLTC | 716-200-4637 | 833-710-1659 | DUAL Members -
All DME & Authorization Requests |
| MLTC | 347-514-6161 | 833-710-1973 | MLTC Members -SNF documents (Authorization Requests, Permanent Placement Forms, PRIs, Notice of Agreement to PP) |
| MLTC | 716-898-0651 | 833-710-1658 | MLTC Members - Appeal Requests |
| Pharmacy - Medicaid/Exchange | 877-533-2405 | 844-235-4852 | Pharmacy Benefit – Initial Request (All requests for drugs obtained a retail pharmacy) Fidelis Care Medication Request Form |
| Pharmacy - Medicaid/Exchange | 877-533-2405 | 844-235-5090 | Pharmacy Medical Benefit – Initial Request (All requests for buy/bill, physician acquired and administered drugs) Fidelis Care Medication Request Form |
| Pharmacy - Medicaid/Exchange | 877-533-2405 | 888-865-6531 | Pharmacy Benefit - Appeal Request |
| Pharmacy - Medicaid/Exchange | 877-533-2405 | 844-235-5091 | Pharmacy Medical Benefit - Appeal Request |
| Pharmacy - Medicare | 877-882-5892 | 844-235-5021 | Pharmacy Benefit - Initial Request |
| Pharmacy - Medicare | 877-882-5892 | 844-235-5090 | Pharmacy Medical Benefit – Initial Request (All requests for buy/bill, physician acquired and administered drugs) Fidelis Care Medication Request Form |
| Pharmacy - Medicare | 877-882-5892 | 833-757-0611 | Pharmacy Medical Benefit - Appeal Request |
| Pharmacy - Medicare | 877-882-5892 | 866-388-1766 | Pharmacy Benefit - Appeal Request |
| Provider Relations – Albany Region | 518-463-8820 | 833-522-2805 | PR Related Communication |
| Provider Relations – Buffalo Region | 716-200-1770 | 833-710-1653 | PR Related Communication |
| Provider Relations – NYC Region | 718-896-1924 | 833-522-2804 | PR Related Communication |
| Provider Relations – Rochester Region | 585-785-4001 | 833-710-1652 | PR Related Communication |
| Provider Relations – Syracuse Region | 315-437-4875 | 833-710-1923 | PR Related Communication |
| Retention | 718-393-6484 | 833-710-1648 | For members to submit documentation required by NYSoH, LDSS or HRA in reference to their Renewal or Enrollment Application. This can be extended for providers as well to send documentation relevant to a members Renewal or Enrollment application. |
| Utilization Management | 716-462-4696 | 833-710-1975 | Discharge Notices for Transition of Care Members Only |
| Utilization Management-Physical Health | N/A | 877-433-7085 | Authorization requests and Clinical Documentation for Home Care (For all Non Long Term Care Members) |
| Utilization Management-Physical Health | N/A | 800-860-8720 | Authorization requests and Clinical Documentation for all Outpatient Procedures/Services and Inpatient Elective Admissions (For example, but not limited to: DME, sleep study, surgery, genetic testing, pain management etc.) (For all Non Long Term Care Members) |
| Utilization Management - Physical Health | 716-803-8307 | 833-663-1611 | Authorization Requests and Clinical Documentation for Inpatient Rehab Admissions (For Non Long Term Care Members) |
| Utilization Management - Physical Health | 347-868-6411 | 833-663-1602 | Authorization Requests and Clinical Documentation for Inpatient ER Admissions (For all Non Long Term Care Members) |