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1-855-GO-AMIDA
Don’t Lose Your Medicaid Benefits -
Act Now
About Us
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Support Our Work
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Careers
Our Plan
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1-855-GO-AMIDA (1-855-462-6432, TTY 711)
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Medicaid Cultural Competency Training Certification
Individual Certification
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*
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)
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*
First Name*
Last Name
Email Address*
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Medicaid Cultural Competency Training Certification
Group Certification
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*
I hereby certify all staff have completed cultural competency training for this year or in the last 12 months. 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
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Organizational TIN
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