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 this Provider Disclosure Certification form to VNSNY CHOICE. Please return it by December 31, 2021.
You can scan the completed document and email it as an attachment to: CHOICEcompliancecertification@vnsny.org.
Or you can print it out and mail it to:
VNSNY CHOICE Health Plans
220 East 42nd Street, Third Floor
New York, NY 10017
ATTN: Provider Operations
CDPAS Recertification – Physician Order Form
CHOICE Total and MLTC Members can have their home care service provided by a consumer directed personal care assistant through Consumer Directed Personal Assistance Services (CDPAS). The Physician Order form is required during the initial assessment and every six months during CDPAS recertification.
Participating PCPs and Specialists: Here’s a quick and easy way to let us know about changes to your information!
To set up EFT payments, fill out this VNSNY CHOICE EFT Request Form by clicking on the link above. Please note: in order to begin receiving EFT payments and remittances, you will also need to enroll with Availity to receive ERA files. See Electronic Payment for Providers for details.
Use this form to submit your claims disputes online. A VNSNY CHOICE representative will get back to you shortly.
Delegated entities are required to submit monthly/quarterly provider rosters.
- The Delegated Entities Provider Roster Template consists of:
- Provider Termination/Add/Update
- Location Termination/Add
- Demographic Updates/Removals
Visit our Credentialing Page for more information.