Provider Resources

Amida Care Community Figures 2

Resources

Live Your Life Undetectable Program Information and Forms

The Live Your Life Undetectable (LYLU) program helps Amida Care members living with HIV become virally suppressed. Participants who enroll in the program with an undetectable viral load or who become undetectable (<200 copies/ml) through participation will receive a financial incentive of $100 for each quarter (three-month period) that they stay undetectable.

Below you will find links to the information and resources you’ll need to support your patients who are eligible for this program:

  • LYLU Provider Training Deck: The information presented during the provider training webinars can be downloaded here, as a refresher or for those who are not able to participate live.
  • LYLU Quick Reference Guides:
  • Forms: Required for patient enrollment, assessment, and ongoing reporting.
    • LYLU Participant Enrollment and Consent (Enrollment) – Review and discuss program requirements with patient and complete form electronically with and on behalf of patient. A completed and signed form is required for patient enrollment. English / Spanish
    • RHIO Consent (Enrollment) – Review RHIO benefits with patient and complete electronically with and on behalf of patient. English/Spanish 
    • LYLU Comprehensive Needs Assessment (Enrollment) – This assessment (or an equivalent) will help you decide which LYLU supportive services are most appropriate for your patients. An assessment is strongly encouraged but not required for program enrollment. English / Spanish
    • LYLU Provider Quarterly Attestation (Ongoing Reporting) – This form must be completed by you or your staff and submitted each calendar quarter for each Amida Care LYLU Program enrolled patient to be eligible to receive their $100 incentive.
  • ShareFile Guide: All forms must be completed electronically, printed, signed, scanned, and securely submitted to Amida Care via the ShareFile system. This Quick Reference Guide gives you easy three-step instructions on setting up your ShareFile account.

Documents and Forms

Provider Manual
Amida Care Formulary

Transgender Coverage Information:

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: providerservices@amidacareny.org, fax: 646-786-1803, or US mail: Amida Care, Inc. c/o Provider Services 14 Penn Plaza, 2nd Floor. New York, NY 10122.
AC Fax Form for Case Submission
This form is only for Medical UM requests.
NYCDOHMH Universal Reporting Form (URF)
Communicable disease reporting and the 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.

For questions about specific Amida Care policies or requirements, please contact us at: 1-800-556-0674.

Clinical Practice Guidelines

NOTE: Amida Care partners with Beacon Health Options to manage behavioral health care and to provide a network of physicians, other licensed professionals, community agencies, and inpatient and outpatient facilities for a full spectrum of behavioral health services that includes mental health and chemical dependency services. Beacon Health Options adopts guidelines for Behavioral Health that are consistent with current standards of care. Amida Care reviews and adopts the behavioral health clinical practice guidelines as recommended by our partner Beacon Health Options.

Behavioral Health

Pediatrics and Adolescents