View Forms and Documents

Use the links below to print/view copies of our most frequently used forms. Forms marked as "East" apply to the Central New York, Central New York Southern Tier and Utica regions.

Quick Tips for Using Correct FormsOpens a PDF

Use the Open Negotiation Notice form for Surprise Bill claims with a service date Jan-01-2022 and after, to negotiate claims priced at Qualified Payment Amount.

Additional Information

Federal No Surprise Bill 
New York Surprise Bill 


Federal Employee Plan (FEP), call 1-800-584-6617 
All others, call 1-800-920-8889


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