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Have questions about
claims or our network?

Our automated phone system is available:
24 hours a day 7 days a week

Live Phone Representatives are available:
9:00 am to 5:00 pm

New York Claims Submission Address:
P.O Box 958438
Lake Mary, FL 32795

New York Request for Review and Reconsideration:
P.O Box 958438
Lake Mary, FL 32795

Electronic Payor ID: 80141

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Provider Forms

Your job is complex enough without having to hunt for forms. Healthfirst makes it simple – by putting all your authorization and request forms in one location.

Downloadable Forms
Below you can find the most up-to-date versions of all relevant authorization and request forms.

Behavioral Health Providers "Areas of Expertise" Form PDF icon image
Block Vision Authorization Form PDF icon image
CareCore Clinical Notes Needed Fax PDF icon image
CareCore PET Scan Certification Form PDF icon image
External Appeals Application Instructions PDF icon image
External Appeals Application PDF icon image
Emergent Admission Fax Form PDF icon image
Hospital Discharge Process PDF icon image
Medical Request for Home Care Form PDF icon image
NYS Medicaid Prior Authorization Request Form For Prescriptions PDF icon image
Request for Outpatient Authorization   PDF icon image
Submitting Medical Necessity Data for Non-Urgent Services PDF icon image


Last update 2014-08-19 11:16