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

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 1-866-265-5983


GDPR Notification Content