Skip to main content

Medicare Administrative and HIPAA Forms

Click below to view important administrative and HIPAA forms for your Medicare journey.

 

Administrative forms include coverage determination, drug claim forms, health care proxy form, appeal requests, and more. 

 

HIPAA Authorization forms include HIPAA form 2(A), 2(D), 2(E) and CMS appointment of representative form. 

 

Medicare Questions?

We're here to help.

1-833-735-4511 (TTY 711)
Oct. 1 - Dec. 31, 8 a.m. - 8 p.m., 7 days a week
Jan. 1 - Sept. 30, 8 a.m. to 8 p.m., Monday - Friday

BlueCross BlueShield of Western New York (BCBSWNY) is a division of HealthNow New York Inc., an independent licensee of the Blue Cross and Blue Shield Association. BCBSWNY complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.  ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia linguistica, Llame al 1-833-735-4515 (TTY 711) 注意:如果您使用繁體中文,您可以免費獲得語言援助服務。請致電 1-833-735-4515 (TTY 711) 

Y0086_MRK2769
Content Last Updated: October 1, 2019