Provider Information & Forms

Below is a list of printable forms and information for our provider’s convenience.

• Redetermination Request Formopens PDF file
• Coverage Determination-Request-Formopens PDF file
• Tier Exception Request Formopens PDF file
• Non-Formulary Exception Request Formopens PDF file

Compliance & Fraud, Waste & Abuse (FWA) Guide & Attestation

• Compliance & Fraud, Waste & Abuse (FWA) Guideopens PDF file
• Attestationopens PDF file

Provider Manuals

• AWNY Provider Manualopens PDF file

Provider Contact and Change Status Forms

• Provider Contact formopens PDF file
• Provider Change formopens PDF file

Model of Care Training

• Provider CareWell 2023 Model of Care Training
• Model-of-Care-Provider Training D-SNPopens PDF file

Opioids

• Opioid Policiesopens PDF file

For questions about the above documents, please contact Provider Relations | 1-718-484-5000 |  providers@agewellnewyork.comcreate new email