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  • Davis Vision Direct Reimbursement Claim Form

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CareFirst BlueCross BlueShield is the shared business name of CareFirst of Maryland, Inc. and Group Hospitalization and Medical Services, Inc. CareFirst BlueCross BlueShield and CareFirst BlueChoice,.

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Superior Vision is an eye-care insurance provider. This company, along with Davis Vision, are subsidiaries of Versant Health.

Please submit claim reimbursement for each patient on a separate claim form. 5. Please note that the member's (or employee's or authorized person's) signature is required on this form. 6. Mail or Email completed claim form to: Vision Care Processing Unit, P.O. Box 1525, Latham, NY 12110 or FedExClaims@davisvision.com.

Members are entitled to an eye examination, including dilation as professionally indicated and two pairs of eyeglasses or contacts. Dependents are entitled to an eye examination, including dilation as professionally indicated and one complete pair of eyeglasses, or one contact lens benefit.

How to Fill Care Health Insurance Claim Reimbursement Form Step 1: Fill Out the Details of the Primary Insured. ... Step 2: Disclose the Insurance History of the Person Filing Claim. ... Step 3: List Down the Details of the Insured Person Hospitalized. ... Step 4: Enter the Hospitalization Information.

Once on the “Forms and Pubs” page, click on the “Member Reimbursement Claim Form” link. Print the form, fill it out and mail it in to the address located on the form. Should you need more assistance, please call customer service at 1 (800) 507-3800.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232