Advance Member Notice Waiver
Use this form to advise a patient that the requested service is a non-covered benefit with BCBSWY.
Direct Deposit Payment
Submit this form to authorize claims payment via direct deposit to your bank account.
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.
Professional Claim Adjustment Request
Use this form to file an adjustment or report an over payment to a professional claim.