Provider Information & Forms
Below is a list of printable forms and information for our provider’s convenience.
Compliance & Fraud, Waste & Abuse (FWA) Guide & Attestation
Provider Quick Reference Guide
PLEASE NOTE: FIDA plan will no longer be offered effective Jan 1, 2019. Claims will still be submitted as appropriate. as appropriate
For a copy of the manual, please contact Provider Relations | 718-484-5000 | firstname.lastname@example.org
Provider Contact and Change Status Forms
Wellness and Prevention Form