If you are interested in signing up for HEALTHeNET, please complete and sign the following documents based on the method of access desired.
Please Note: Before submitting a new request for access to HEALTHeNET, please verify that your organization has received confirmation from the insurance carriers that you have successfully credentialed with them. Failure to credential with the insurance carriers could lead to delays or denial of your HEALTHeNET setup request.
Examples of changes that need to be communicated with the insurance carriers include:
- New Tax ID for your group
- New group setup
- Changes to an existing group including name change, new locations, and addition of new providers
Insurance Carrier Contact Information
- BlueCross BlueShield of Western New York
- BlueShield of Northeastern New York
- Independent Health
- Nova – Please contact Nova’s Provider Service Department at (716) 733-2122 or 1-800-999-5703
- Univera Healthcare
For access to HEALTHeNET through the online portal, please complete the following documents:
- HEALTHeNET Data Recipient Agreement
- HEALTHeNET Data Recipient Terms and Conditions
- Tax ID Number Attestation Form
- HEALTHeNET Group Management Form
- HEALTHeNET User Account Form (For setting up Authorized Contacts Only [All other users will be set up online by Authorized Contact])
Net Exchange (Direct Connect)
Please Note: there could be costs associated with a system to system connection. More information is available upon submission of the request.
Please submit completed forms and questions to:
- Email to email@example.com
- Fax to (716) 206-0996 with Attention: HEALTHeNET Account Request
- Mail to HEALTHeNET, 2475 George Urban Blvd., Suite 202, Depew, NY 14043