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1-855-GO-AMIDA
About Us
About Us
Our Sponsors
Our Model of Care
Our Leadership
Board of Directors
Executive Team
Advocacy and Research
Support Our Work
Corporate Compliance
Careers
Our Plan
Medicaid Live Life Plus
Your Care Team
Provider Network
Pharmacy
PrEP & PEP
Dental and Vision
Behavioral Health
Children’s Services
Transgender Health / TGNB
Joining the Plan
FAQs
For Members
Member Programs and Services
Find a Provider
Member Handbook
My Amida Care App
Healthy Rewards
Live Well
Live Your Life Undetectable
Live Your Life Wellness Program
Member Voices
Member FAQs
For Providers
Provider Services
Utilization Management
Pharmacy Information
Restricted Recipient Program
FAQS
Find a Provider
Joining the Provider Network
Provider Resources
Provider News
Cultural Competency Training Attestation
Resources
Health Resources
Virtual Trips
Publications
Media Center
Amida Care News
Blog
Media Coverage
Press Releases
Events
Fast Facts About Us
Media Tools
Contact
How to Reach Us
Report Fraud
-
A
+
A
Language
English
Spanish
1-855-GO-AMIDA (1-855-462-6432, TTY 711)
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April 20 2021
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Medicaid Cultural Competency Training Certification
Individual Certification
Accept
*
I hereby certify Amida Care participating providers have completed cultural competency training this year or in the last 12 months. I acknowledge this training and certification is required annually by the New York State Department of Health. I declare the above statement is true and accurate to the best of my knowledge. Additionally, this will confirm I hold the authority to complete this certification.
Provider Tax ID Number
*
Provider Information
*
Provider First Name*
Provider Last Name*
NPI Number* (e.g., 1234567890)
Information completed by
*
First Name*
Last Name
Email Address*
Relationship to above-named provider (e.g., self, office manager, nurse, other)
*
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Medicaid Cultural Competency Training Certification
Group Certification
Accept
*
I hereby certify all staff have completed cultural competency training for 2022. I understand this certification is required annually by the New York State Department of Health. I confirm new providers/staff who join our group will complete the Medicaid Cultural Competency Training and the group will submit an updated provider list and certification upon request by the Plan. I declare that the above statement is true and accurate to the best of my knowledge. Additionally, this will confirm that I hold the authority to make this certification.
Name of Authorized Person
*
First Name*
Last Name
Email Address*
Title of Authorized Person
*
Delegate Name
*
Organizational TIN
*
Number of Providers
*
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Member assistance and crisis support are available 24 hours a day, seven days a week. Call toll-free:
1-800-556-0689 TTY 711
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