[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-1-en-105":3,"doc-seo-275208-105":53,"doc-detail-275208-en":127},{"code":4,"msg":5,"data":6},0,"success",[7,14,19,24,29,34,39,44,49],{"id":8,"doc_module":9,"doc_module_name":10,"category_name":11,"show_sort_weight":12,"slug":13},11,1,"Template","Presentations",90,"presentations",{"id":15,"doc_module":9,"doc_module_name":10,"category_name":16,"show_sort_weight":17,"slug":18},12,"Resumes",80,"resumes",{"id":20,"doc_module":9,"doc_module_name":10,"category_name":21,"show_sort_weight":22,"slug":23},14,"Invoices",70,"invoices",{"id":25,"doc_module":9,"doc_module_name":10,"category_name":26,"show_sort_weight":27,"slug":28},15,"Posters",60,"posters",{"id":30,"doc_module":9,"doc_module_name":10,"category_name":31,"show_sort_weight":32,"slug":33},16,"Social Media",50,"social-media",{"id":35,"doc_module":9,"doc_module_name":10,"category_name":36,"show_sort_weight":37,"slug":38},17,"Forms",40,"forms",{"id":40,"doc_module":9,"doc_module_name":10,"category_name":41,"show_sort_weight":42,"slug":43},18,"Letters",30,"letters",{"id":45,"doc_module":9,"doc_module_name":10,"category_name":46,"show_sort_weight":47,"slug":48},21,"Paper Templates",5,"papers-templates",{"id":50,"doc_module":9,"doc_module_name":10,"category_name":51,"show_sort_weight":4,"slug":52},158,"General","general-158",{"code":4,"msg":54,"data":55},"ok",{"site_id":56,"language":57,"slug":58,"title":59,"keywords":60,"description":61,"schema_data":62,"social_meta":120,"head_meta":122,"extra_data":124,"updated_unix":126},105,"en","excellus-bcbs-letter-of-authorization-release-of-coverage-information","Excellus BCBS Letter of Authorization - Release of Coverage Information","","Authorization letter template for submitting on group letterhead to Excellus BCBS, addressed to Broker Administration. It grants the named broker agency permission to receive and release information related to the company’s coverage. The letter clarifies that the broker is not authorized to act on the company’s behalf for benefit updates or changes and receives no compensation. 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It requires the broker agency name and address details as well as the company officer signature information.","Answer",{"name":112,"@type":107,"acceptedAnswer":113},"What does this authorization allow the broker agency to do?",{"text":114,"@type":110},"It authorizes Excellus Health Plan to release information related to the company’s coverage to the broker agency listed in the letter.",{"name":116,"@type":107,"acceptedAnswer":117},"How long is the authorization valid and can it be revoked?",{"text":118,"@type":110},"The authorization remains in effect for six months from the listed effective date. It can be revoked if the company notifies Excellus BlueCross BlueShield in writing to the contrary.","https://schema.org",{"og:url":78,"og:type":121,"og:title":59,"og:site_name":91,"og:description":61},"article",{"robots":123,"canonical":78},"index,follow",{"doc_id":125,"site_id":56},275208,1789999520,{"code":4,"msg":5,"data":128},{"doc_id":125,"user_id":129,"nickname":88,"user_avatar":130,"doc_module":9,"category_id":40,"category_name":41,"doc_title":59,"doc_description":61,"doc_content":131,"file_id":132,"file_url":133,"file_type":134,"file_size":135,"view_count":101,"is_deleted":4,"is_public":9,"is_downloadable":9,"audit_status":9,"page_count":9,"language":136,"language_code":57,"site_id":56,"html_lang":57,"table_of_contents":137,"faqs":138,"seo_title":139,"seo_description":61,"update_tm":140,"read_time":4},7421720224475,"https://ap-avatar.wpscdn.com/davatar_276721f389ce27ea32af1340a28f341c","(TO BE SUBMITTED ON GROUP LETTERHEAD)  \nLetter of Authorization  \nExcellus BCBS  \nAttn: Broker Administration  \n165 Court Street  \nRochester, New York 14647  \nBroker Agency Name:  \nBroker Agency Address:  \nCity, State, Zip Code  \nDear Broker Administration Team:  \nEffective (date), Our company hereby authorized Excellus Health Plan  \nto release information pertaining to our companies All coverage to the  \nBroker Agency named above.  \nWe understand this letter does not authorize the above-named Broker to act on our behalf regarding any updates or changes to our current benefits and does not entitle them to any form of compensation.  \nThis designation shall remain in effect for 6 months from the date listed above or unless we notify Excellus BlueCross BlueShield in writing to the contrary.  \nSincerely,  \nSignature of Company Officer  (e-signatures accepted if authenticated)  \nPlease print (Officer Name)  \nTitle of Company Officer","cbCaim38wAPp7bQl","https://ap.wps.com/l/cbCaim38wAPp7bQl","pdf",121225,"English","# Letter of Authorization\n## Recipient and Address\n## Authorized Broker Agency Details\n## Authorization Scope and Limits\n## Effective Period and Revocation\n## Signature and Officer Information","[{\"question\":\"Who is the letter addressed to and what information must be included?\",\"answer\":\"The letter is addressed to Excellus BCBS, Attn: Broker Administration, with the full address provided. It requires the broker agency name and address details as well as the company officer signature information.\"},{\"question\":\"What does this authorization allow the broker agency to do?\",\"answer\":\"It authorizes Excellus Health Plan to release information related to the company’s coverage to the broker agency listed in the letter.\"},{\"question\":\"How long is the authorization valid and can it be revoked?\",\"answer\":\"The authorization remains in effect for six months from the listed effective date. It can be revoked if the company notifies Excellus BlueCross BlueShield in writing to the contrary.\"}]","Excellus BCBS Letter of Authorization - Release of Coverage Information | PDF",1789485705]