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Get Davis Vision Direct Reimbursement Claim Form
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How to fill out the Davis Vision Direct Reimbursement Claim Form online
Filling out the Davis Vision Direct Reimbursement Claim Form online is an important step in receiving reimbursement for your vision care expenses. This guide provides clear, step-by-step instructions to help you accurately complete the form, ensuring a smooth submission process.
Follow the steps to successfully complete the form online.
- Press the ‘Get Form’ button to obtain the Davis Vision Direct Reimbursement Claim Form and open it in your online document editor.
- Begin by entering your member information, including your full name, member identification number, mailing address, and contact phone numbers. Make sure to print clearly to avoid any issues.
- Provide the patient information by filling in the patient's name, relationship to the member, and date of birth. Ensure all sections are accurately completed.
- Fill out the provider information section, which includes the names, addresses, state license numbers, and contact numbers of both the examiner and dispenser.
- In the service section, indicate the services performed by checking the appropriate boxes and entering the date of service and the amount charged for each item. Be thorough, as only the listed services will be considered for reimbursement.
- Read through the member certification statement carefully. Your signature and the date are required to validate the information provided and authorize the release of any necessary information for processing the claim.
- Once you have filled out all sections, review the form for completeness to prevent any delays. Save your changes and take note of any additional documents you may need to include.
- Finally, download and print the completed claim form. Mail the claim form to the Vision Care Processing Unit at the provided address to ensure your claim is processed.
Complete your claims process by filling out your documents online today.
The steps for reimbursement typically begin with completing the Davis Vision Direct Reimbursement Claim Form. Start by entering your personal details and listing all eligible expenses along with their receipts. After ensuring everything is accurate, submit the claim via mail or online, as directed, to receive your reimbursement promptly.
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