Davis Vision Claim Form Out Of Network. Web use this form to request reimbursement for services received from providers who do not participate in the davis vision network. When filled out, please send them to us by emailing lbs@versanthealth.com.
Claim Form Davis Vision Claim Form
Web use this form to request reimbursement for services received from providers who do not participate in the davis vision network. Enter the date of service in the following format: If another insurance company is involved, check the box and attach a copy of the statement showing payment. Do members need a claim form for services? Log in to your account and click on “access benefits and forms” to download the direct reimbursement claim form. Expenses for both examinations and eyewear can be claimed on this form. Can members receive care from the eye care professional of their choice? Only one patient’s services may be claimed on this form. Enter the amount charged for each applicable line item. Vision care processing unit, p.o.
Web please download the below documents. Box 1525, latham, ny 12110. Only one patient’s services may be claimed on this form. What is your position on telehealth services? Enter the date of service in the following format: Web use this form to request reimbursement for services received from providers who do not participate in the davis vision network. Web please download the below documents. Can members receive care from the eye care professional of their choice? Web mail completed claim form to: Client / group name the request is regarding letter of authorization from client / group effective date broker name broker address Log in to your account and click on “access benefits and forms” to download the direct reimbursement claim form.
