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Please contact Karen Hodge, Management Services Specialist, at (585) 344-7566 or email the Specialist for any questions regarding forms. Please click the links below to download the appropriate forms.

• Excellus BCBS Dental Claim Form

• Excellus BCBS Medicare Eligibility Form

• Excellus BCBS Medical Claim Form

• Adult Disabled Dependent Form

• Dependent Adoption Form

To find the Excellus BCBS Protected Health Information form (PHI), click on this link: Excellus BCBS PHI Form.  This form is used to authorize Excellus BCBS to share your protected health information with each person you authorize on the form.  Excellus BCBS is not able to provide you with any protected health information for anyone 18 years or older on your plan unless one of these forms is on file.