Provider Modification Form
The purpose of the Provider Modification Form is to Communicate Name, Address, and Other Office Changes to Amida Care.
To ensure that Amida Care and our members have the most up-to-date information about your practice, we are pleased to introduce the updated Provider Modification Form.
When you are changing your practice name, address, phone numbers, e-mail, billing company, or other practice information, you only need to complete this single form and send it via email, fax, or US mail.
For questions about specific Amida Care policies or requirements, please contact us at: 1-800-556-0674
Communicable disease reporting and the Universal Reporting Form (URF):
NYCDOHMH disease surveillance is a cornerstone of overall health of all NYC residents. To that end, it is essential that all providers promptly report all communicable diseases and conditions as required by law on the NYCDOHMH Universal Reporting Form (URF) . For any questions or to report cases immediately, call the DOH Provider Access Line at 1-866-NYC-DOH1 or, after hours, the Poison Control Center at 1-800-222-1222.
USDHHS National Guidelines for the Treatment of HIV, Clinical Trials and other health topics
Learn more about Amida Care’s work to advance treatment and cure of Hepatitis C:
New York State Department of Health AIDS Institute HIV Clinical Resource HIV guidelines
USDHHS HIV treatment, prevention, research, guidelines, clinical trials
New York State Department of Health
Office of the Inspector General