Provider Forms

Provider Forms

Download and print commonly used forms. All forms are in PDF format. Download Acrobat Reader.

Direct Deposit Payment

Submit this form to authorize claims payment via direct deposit to your bank account.

Professional Claim Adjustment Request

Use this form to file an adjustment or report an over payment to a professional claim.

Institutional Claim Adjustment Request

Use this form to file an adjustment or report an over payment to an institutional claim.

Other Coverage Questionnaire

This form is used to verify the health care coverage of your patients and to assist you in determining primary and secondary coverage.

Practice / Office Information

Use this form to update provider or office contact information with BCBSWY.

Prior Authorization Request

This form may be used by a health care provider to notify BCBSWY of a patient’s intent to receive services requiring prior certification.

Availity Provider Portal
Verify eligibility and benefits, submit claims, and more.
Provider Resources

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