Why Participate in the Amida Care Provider Network?

Benefits for Providers:

Care Team (including the Member/patient) advocates for what is medically necessary
Decisions are made by Providers with Members
Quick approvals by Plan - because decisions are made by the HIV PCP & Medical Director
Plan facilities coordination with the hospitals, specialists, community case management and Community Based Organizations (CBOs)
Flexibility allows for members benefits that Medicaid might not offer
Monthly Health Promotional event for Members
Health Maintenance Incentives for Members who make their appointments
Available outreach and escort services to help get your patients to their appointments
Prevention for Positives' initiatives

A full picture of utilization including pharmacy data, summary of lab values and services from other providers including inpatient and outpatient services
Advocacy for the Primary Care Provider who has difficulty obtaining medical records/reports post hospitalization, ER visits, or specialty care
Access to specialists who might not otherwise accept Medicaid insured patients
Access to specialists in their office vs. a clinic setting
Assistance with appointment scheduling

A Care Coordinator is assigned to each new Member. He or she has the responsibility to work with Members and their Providers to facilitate access to needed care and services. New Members are also referred to a community case manager who assesses their case management needs. Other case managers, e.g., COBRA or Day Treatment, are contacted for the purpose of introduction and explanation of the Amida Care Care Coordinator's role.

All Members are initially and continually assessed for chemical dependence treatment needs. Members are encouraged to get treatment for these issues. Arrangements can be made by the PCP or Care Coordinator for referrals to chemical dependence treatment. The plan works closely with the treatment Provider, Member, and PCP to monitor progress in treatment and develop a discharge plan.

Care Coordinators, community case manager, and Member Services staff are in contact with the Members on a regular basis.
Members determined to be at risk for falling out of care are supported by a Community Health Outreach Worker (CHOWs). CHOWs provide telephonic support and may escort members to appointments.
Members are invited to membership meetings every three (3) months where they can express general concerns and recommendations to the Plan. Members are elected to a Member Advisory Council (MAC) that brings these concerns and recommendations to the Amida Care Board of Directors. Two (2) members of the MAC serve on the Plan’s Board of Directors.

Specialty medical care is increasingly important to Members. Other conditions such as kidney, liver, and heart disease require close coordination of care between the specialist and the HIV PCP. By including private specialists in the network, PCPs have more options to offer their patients.

Members call 800–556-0689 for Member Services. Member Services works closely with care coordination to ensure that questions are answered and the Member gets the assistance they need. For example: A Member calls with a question about how to obtain specific dental services. Although the dental care remains covered under FFS Medicaid; a referral is made to a dental Provider and transportation is arranged by the Plan.

PCPs or covering Providers must be available to their members 24/7/365. The Plan’s Member Services Department at 800-556-0689 is answered by a live person 24/7/365. There is always an Amida Care Administrator on-call for Member or Provider issues.

Call the Provider Services Department at 1-800-556-0674.

I learned how to read my T-cell count plus my viral load. I also learned the names of the medications I take…”