MANDATORY FIELDS: The following columns of the data call are mandatory fields for insurers with paid claims. Use this form if you receive a surprise bill for health care services and want the services to be treated as in network.How do I fill this out? Members and health care professionals can find forms needed to apply for benefits, and learn about member rights and responsibilities. Use this form if you receive a surprise bill for health care services and want the services to be treated as in-network. In order to request a transfer, you must fill out the Transfer Request Form. The quickest way to apply for Government Assistance is online through the MyACCESS portal.