MIPAA Compliant Release of Information Form:

Because CCM is involved in the administration of your self-funded program, most providers will not require that you complete this form to share information with us. However, some providers who may not be familiar with CCM may ask for a release.  It is also helpful to complete and fax a copy to us, so we can let them know there is a release on file. Thank you!

FAX for Health Plan Benefits- Health Case Management (607) 648-6444  

FAX for Workers' Compensation Case Management (607) 648-3442                         For More Information Visit: http://www.wcb.ny.gov/



We can accomplish almost anything within our ability if we but think that we can! - George Matthew AdamsCMDM