The Lifetime Healthcare Companies - Providing health coverage and health care services

Vendor Consent Forms

Click the links below to view and print copies of our consent forms. All files are in PDF format. You will need Acrobat Reader to open and print these files. If you don't already have Acrobat Reader, you may down load it (FREE) at Adobe.com


Excellus BlueCross BlueShield

Electronic Consent
Electronic Consent for CAQH 270/271 and 276/277 for Providers
Electronic Consent for CAQH 270/271 and 276/277 for Agents
Schedule C - Remit
CAQH CORE - Electronic 835 Consent Form
CAQH CORE - Electronic 835 Consent Eform

Univera Healthcare

Electronic Consent
Electronic Consent for CAQH 270/271 and 276/277 for Agents
Schedule C - Remit
CAQH CORE - Electronic 835 Consent Form
CAQH CORE - Electronic 835 Consent Eform