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Get Simple Vision Claim Form
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How to fill out the Simple Vision Claim Form online
Filing a vision claim can be a straightforward process when you follow the right steps. This guide will provide you with detailed instructions on how to fill out the Simple Vision Claim Form online effectively.
Follow the steps to complete your claim form accurately.
- Press the ‘Get Form’ button to obtain the Simple Vision Claim Form and open it in your preferred online document editor.
- Carefully fill in your personal information in the appropriate fields, including your last name, first name, employer name or group number, social security number or member ID number.
- Provide the mailing address where you would like the claim payment to be sent. Ensure to include your name, street address, city, state, and zip code.
- Enter the details for the ‘patient,’ including their last name, first name, date of birth, and social security number or member ID number.
- Indicate the relationship of the patient to you, the employee, by selecting the appropriate option from the choices provided.
- Input the date of your visit and the name of your vision care provider in the designated fields.
- List each item or service purchased during the visit, entering the corresponding prices for each item in the provided spaces. Ensure to include all relevant items to avoid underreporting.
- Calculate the total amount spent on vision care and enter this sum in the designated total field.
- Attach a detailed or itemized receipt that includes the date of service, patient name, procedures purchased, and costs. Ensure that your attached receipt meets these requirements.
- Once you have completed the form and attached the necessary documentation, submit the claim. You can do this by mailing the form to the address provided, faxing it, or sending it via email.
- Remember to submit only one claim form and receipt at a time to ensure processing.
- After submission, you can save your changes, download a copy for your records, or print the completed form as needed.
Start completing your Simple Vision Claim Form online today to ensure timely claim processing.
You typically have up to one year from the date of service to submit a VSP claim. It’s best to complete your Simple Vision Claim Form promptly to avoid missing any deadlines. Staying proactive will ensure you receive your entitled benefits without unnecessary delays.
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