Provider Services

Services for Health Care Professionals

Provider Services Representatives are available to assist providers with billing, claims payment issues, and other information every business day, 9 am to 5 pm, at 1-800-556-0674.

Credentialing

Amida Care is committed to providing health care services to its membership through a high-quality provider network that meets the standards outlined by regulatory and oversight agencies, including the Centers for Medicare and Medicaid Services (CMS), New York State Department of Health AIDS Institute, the National Committee for Quality Assurance (NCQA), and/or the Joint Commission and Accreditation of Healthcare Organizations (JCAHO).

Contact information:

Email: providerservices@amidacareny.org
Phone: 1-646-757-7000 (Monday – Friday 8:00am to 5:00pm)

Keep Your Provider Information Current

It’s Important for You, Your Patients, and Us

Amida Care strives to go above and beyond for our clinicians and our members.

Please assist us by ensuring that provider addresses, phone numbers, specialties, and office hours are current. This is key to the accuracy of the Amida Care Provider Directory.

You may verify your provider demographic information by clicking on Find a Provider or by calling us at 1-800-556-0674

Provider file updates can be made via phone, by emailing us or by faxing 646-786-1803.

Amida Care values your participation and commitment to our members.

Mandatory Compliance Program Certification

As per the Office of Medicaid Inspector General (OMIG) requirement, Medicaid providers adopting and maintaining an effective compliance program will attest to this as part of their annual “Certification Statement for Provider Billing Medicaid.” This annual certification shall occur on the anniversary date of the provider’s enrollment in Medicaid, which can be found on your initial Medicaid enrollment welcome letter. Additionally, each year, approximately 45-60 days before the anniversary of a provider’s enrollment, the NYS Department of Health (NYSDOH) sends by mail a package of information and materials to providers, which includes the Certification of Statement for Provider Billing Medicaid Form and instructions on how to submit the form.

Amida Care is required to keep a copy of our Participating Providers annual “Certification Statement for Provider Billing Medicaid”. Once you have completed your certification, kindly provide Amida Care a copy of your notice of certification via email to: Medicaidcertificationstatement@amidacareny.org

Amida Care’s Value-Based Program

Amida Care’s Value-Based Program (VBP) is designed to improve the quality of care, while focusing on our members’ health outcomes and by controlling costs. Here are our seven (7) key principles:

1. Quality over Quantity – Reward providers based on quality of care they deliver rather than the volume of services.
2. Care Coordination – Prioritization of better patient outcomes, improve health management, and patient satisfaction.
3. Social Determinants of Health – Focus to reduce disparities, such as: access to healthcare services, safe housing, healthy food, social support, and access to other resources.
4. Patient-Centered Care – Enhance the overall patient experience, including satisfaction and engagement.
5. Cost-effectiveness – Target to reduce unnecessary spending by encouraging preventative care, better management of chronic conditions, and reducing hospital readmissions.
6. Performance Metrics- Establish key benchmarks and performance indicators for providers to achieve while tracking/evaluating the effectiveness of rendered services.
7. Shared-Savings/Shared Risk – Healthcare payment models aim to align incentives between the contracted providers and Amida Care to improve care quality and reduce cost with the goal of staying under a predetermined budget.

Amida Care Live Undetectable Program

Amida Care now offers a viral load suppression member incentive program, Live Undetectable. The program provides your patients who are enrolled with Amida Care with a financial incentive of $100 for each quarter (three-month period) of demonstrated viral load suppression (<200 copies/ml) along with their participation in supportive services like case management or other provider-recommended medication adherence supports.

We greatly value and appreciate your partnership and alignment with our goal of improved patient health. For more details, please see the Live Undetectable tab at the top of the Provider Resources page.

Electronic Claims Submission

Amida Care encourages our providers to file claims electronically. Submit institutional and professional claims through Smart Data Solutions clearinghouse – https://portal.smartdatastream.us. Amida Care’s electronic submitter ID# is 79966. If you are a provider who does not have claims submission software, you can mail claims directly to: AMIDA CARE Claims, P.O. Box 21455, Eagan, MN 55121.

Provider Portal Offers Quick, Easy Access to Patient Information

Amida Care Online is a secure electronic portal developed specifically for you, our providers. This state-of-the-art tool enables you to gain immediate access to real-time data about claims, authorization status, member eligibility, and other patient information.

To register for the portal, please call 1-800-556-0674 for support.