NYDocSubmit is an app for mobile devices and is available for download in the Apple App Store and Google Play Store. I am fully satisfied with the beneficiary designation, and I consent to and accept the designation, without regard to whether I survive or predecease my spouse.If you wish to submit qualifications, please fill out the document completely. View, download, and print the most frequently used Excellus BlueCross BlueShield forms including claims submission, reimbursement, and enrollment forms. Insured's ID Number. (Patient's Medicare Health Insurance Claim Number - HICN). This free program will help you create the affidavit that you will need to file in Surrogate's Court. You would need an official letter from the agency saying you need the death record to process the claim. HIPP helps families with at least one person enrolled in Medicaid pay for private health insurance offered through an employer. These are electronic federal tax forms, equivalent to a paper 1040 and are designed for taxpayers who are comfortable filling out IRS tax forms.