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Vendor Consent Forms

Consent Forms

Click the links below to view and print copies of our consent forms. 


Excellus BlueCross BlueShield

Electronic ConsentOpen a PDF
Electronic Consent for CAQH 270/271 and 276/277 for ProvidersOpen a PDF
Electronic Consent for CAQH 270/271 and 276/277 for AgentsOpen a PDF
Schedule C - RemitOpen a PDF
CAQH CORE - Electronic 835 Consent FormOpen a PDF
CAQH CORE - Electronic 835 Consent Eform

Univera Healthcare

Electronic ConsentOpen a PDF
Electronic Consent for CAQH 270/271 and 276/277 for AgentsOpen a PDF
Schedule C - RemitOpen a PDF
CAQH CORE - Electronic 835 Consent FormOpen a PDF
CAQH CORE - Electronic 835 Consent Eform