Provider Frequently Asked Questions (FAQs)

1. Where do I send claims?

   Amida Care Claims Department
   PO Box 6022
   Hauppauge, NY 11788

   Electronic Submissions:
   Use Amida Care Submitter ID # 24818
2. How do I check the status of a claim?
   Call Provider Services at 1-800-556-0674
3. How can I appeal a claim denial?
   You have 60 days from the date of a claim denial to submit an appeal. To file an appeal, mail the Statement of Remittance (SOR) denial that you received from Amida Care along with supporting documentation to:

   Amida Care Appeals Department
   4944 Parkway Plaza Blvd, #110
   Charlotte, NC 28217

   For further information on appeals of medical surgical services, call Amida Care’s Medical Services Utilization Management at 1-800-447-8681; for inpatient or outpatient behavioral health appeals, call Amida Care’s Behavioral Health Services Utilization Management at 1-866-752-5443.
4. When will I receive payment for submitted claims?
   Amida Care complies with New York’s prompt pay laws that requires health plans to pay undisputed claims and bills within 45 days of receipt.
5. What is SNP QARR?
   Quality Assurance Reporting Requirements (HIVQARR). Amida Care is required by the NYS DOH AIDS Institute to report HIV QARR data. This data is comprised of a series of measures of managed care plan performance. These measures are largely adopted from the NCQA and HEDIS reporting requirements with additional specific measures added to address the care of HIV-infected persons.
6. How do I verify Member eligibility?
   Call Amida Care Member Services at 1-800-556-0689
7. What services require an authorization?
   Please see the Provider Benefit Guide and UM Rules  to determine which services require pre-authorization.

For more detailed information, please see the Provider Manual.

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