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

Provider Manuals

PLEASE NOTE:  FIDA plan will no longer be offered effective Jan 1, 2019.  Claims will still be submitted as appropriate.

For a copy of the manual, please contact Provider Relations | 718-484-5000 |  providers@agewellnewyork.comcreate new email

Provider Contact and Change Status Forms

Model of Care Training


Provider Newsletters

Watch the mail and your inbox for the next newsletter – coming this summer!
AgeWell New York is providing email updates on a regular basis. Be sure we have the correct email address on file so you don’t miss out on important information.