View Forms and Documents

Use the links below to print/view copies of our most frequently used forms. If you have questions, please contact Customer Care at 1(866) 265-5983 or Provider Relations at UniveraPR@Univerahealthcare.com.

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 

Questions

Federal Employee Plan (FEP), call 1-800-584-6617 
All others, call 1-866-265-5983

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