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Fidelis pcp change form

Fidelis change doctor 2025

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The document is a Primary Care Provider Change Request form for Fidelis Care members, allowing them to request a change of their primary care provider (PCP). It includes fields for member information, current and new PCP details, and instructions for submission via fax. The document also notes that certain plans do not require PCP assignments and advises providers to verify member assignments through Fidelis Care's online portal or customer service.

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Click ‘Get Form’ to open the fidelis change doctor form in the editor.
Begin by entering your Member Name and Date of Birth (DOB) in the designated fields.
Input your Fidelis Care Member ID for identification purposes.
Indicate whether you have visited a primary care provider (PCP) in the past month by checking the appropriate box.
If you have visited a PCP, provide their name and the date of service in the specified area.
Fill in the effective date for your new PCP assignment, ensuring it is accurate.
Enter your current primary care provider's name and then fill out the new PCP's details, including their TIN, practice name, fax number, address, and telephone number.
Sign and date the form at the bottom to confirm your request.

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Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

What do I need to transfer doctors?

Scheduling a Final Visit With Your Current Doctor Get a status report of the condition the provider is treating. Get or request copies of your medical records. Request prescription refills to tide you over during the transition. Request delivery of your medical records and notes to your new provider.

How to change doctor Fidelis Care?

Members can also change a PCP over the phone by calling 1-888-FIDELIS (1-888-343-3547). PCP Change Effective Date: Typically the 1st of the month when the form is received by Fidelis Care.

How do I transfer files from one doctor to another?

If you want to ensure that your new doctor receives a copy of your medical records from your previous doctor, you can write your previous doctor requesting that a copy of your medical records be sent directly to you. When you receive your records, you can provide a copy of those records to any provider you choose.

How do you tell your doctor you want to switch doctors?

You dont need to say anything to your current primary care doctor; just put in your request to be reassigned to the other doctor that youve selected. Your current doctor has tons of patients and wont notice or care that one has switched.

Is Fidelis Healthier Life Medicaid?

HealthierLife is Fidelis Cares Health and Recovery Plan (HARP) for qualifying Medicaid Managed Care members.

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Is Fidelis an HMO or PPO?

Wellcare Fidelis No Premium (HMO) and Wellcare Fidelis Assist (HMO-POS) have a network of doctors, hospitals, pharmacies, and other providers. You can save money by using our preferred mail-order pharmacy and by using providers in the plans network.

How do I transfer to a new primary care doctor?

How to Change Your Primary Care Physician: A Step-by-Step Guide Step 1: Identify Your Reasons for Change. Step 2: Research Potential New PCPs. Step 3: Schedule a Consultation. Step 4: Transfer Your Medical Records. Step 6: Schedule Your First Appointment. Step 7: Complete a Trial Period.

How do you switch primary care doctors?

Heres a three-step plan for switching primary care providers: Step 1: Find a New Physician. You dont want to leave your current primary care provider until you have found a new physician. Step 2: Make Sure You Have Your Medical Records. Step 3: Connect with Your New Office. Get Help Switching Primary Care Providers.