Forms for Providers and Patients
Here you can find forms to join our network, update your demographic information, get prior authorizations for a patient’s medications, and more. You can find credentialing forms by clicking on this link.
Provider Disclosure Certification
You are required to fill out and return the provider disclosure certification form to VNS Health Health Plans. Please return it by December 31, 2021.
You can scan the completed document and email it as an attachment to: [email protected].
Or you can print it out and mail it to:
Health Plans – Provider Operations
220 East 42nd Street
New York, NY 10017
CDPAS Recertification – Physician Order Form
Please note that to begin receiving EFT payments and remittances, you will also need to enroll with Availity to receive electronic remittance advice files. See Electronic Payment for Providers for details.