A part of the Visiting Nurse Service of New York »
Forms
VNS CHOICE providers and members can find and download the forms they need right here.
The following forms are available as PDF's. Please print out the form(s) that you need and mail them to the appropriate address, listed below.
- Medical Coverage Determination Form
- Request for Continuity of Care for Medical Benefits (Transitional Care Form)
- Request for Medicare Prescription Drug Coverage Determination
- Request for Medicare Prescription Drug Coverage Exception
- Claims Dispute Form
- Waiver of Liability Form
- Detailed Information on the Provider Dispute Process
Appeals and grievances should be mailed to:
VNS CHOICE
1250 Broadway, 3rd floor
New York, NY 10001
Please click here for an overview of the VNS CHOICE Claims Dispute process.
Contact
If you are having trouble accessing these forms or finding the form you need, please call Provider Services at 1-866-783-0222 between 8 AM and 8 PM, seven days a week.
