Davis Vision Claim Form. Each patient’s services must be claimed on a separate form. Web direct reimbursement claim form important information:
Download Davis Vision Claim Form PDF
Web direct reimbursement claim form important information: Web direct reimbursement claim form important information: Davis vision complaints and appeals department p.o. Expenses for both examinations and eyewear can be claimed on this form. Be sure that all sections have been completed and that you and the provider(s) have. Only services listed on this form will be considered for reimbursement. Each patient’s services must be claimed on a separate form. Be sure to keep a copy for your records. Expenses for both examinations and eyewear can be claimed on this form. Box 791 latham, ny 12110 fax:
Expenses for both examinations and eyewear can be claimed on this form. Use this form to request reimbursement for services received from providers who do not participate in the davis vision network. Be sure that all sections have been completed and that you and the provider(s) have. Web direct reimbursement claim form important information: Davis vision is a separate company that performs claims administration for your vision program. Expenses for both examinations and eyewear can be claimed on this form. Please submit to the following contact: Only services listed on this form will be considered for reimbursement. Client / group name the request is regarding; This change aligns davis vision and superior vision with cms guidelines on paper claims submission. Expenses for both examinations and eyewear can be claimed on this form.
