Loading
Get Download And Print A Davis Vision Direct Reimbursement Claim Form
How it works
-
Open form follow the instructions
-
Easily sign the form with your finger
-
Send filled & signed form or save
How to fill out the Download And Print A Davis Vision Direct Reimbursement Claim Form online
Filling out the Download And Print A Davis Vision Direct Reimbursement Claim Form can be straightforward when you follow a specific process. This guide will provide you with step-by-step instructions to ensure that your claim is completed accurately and efficiently.
Follow the steps to complete your claim form correctly.
- Click the ‘Get Form’ button to obtain the claim form and open it in your preferred editor.
- Begin by filling out the Member/Employee Information section clearly. Include your first name, middle initial, last name, and Member Identification Number as found on your Vision Identification card. Complete your mailing address along with your business and home phone numbers.
- Proceed to the Patient Information section. Enter the patient’s full name, relationship to the member, and date of birth. If applicable, provide information about any other vision insurance coverage they may have.
- In the Provider Information section, complete details for both the examiner and dispenser. This includes their names, addresses, state license numbers, and phone numbers.
- Specify the services received in the Service section. For each service—such as eye examination, lenses, and fittings—fill in the date of service and corresponding amount charged, ensuring to check relevant options for lenses and fitting types.
- Complete the Member/Employee Certification by signing and dating the form, certifying that all provided information is accurate and acknowledging the fraud statement.
- After completing the form, review all sections for completeness. Save any changes, and then you can download the form for printing. Finally, mail the completed claim form to the provided address: Davis Vision, P.O. Box 1525, Latham, NY 12110.
Start filling out your claim form online now to ensure a smooth reimbursement process.
The VSP controversy often revolves around the adequacy of their coverage and reimbursement timelines. Many users express frustration over delays or insufficient compensation for services. Understanding how to navigate this system, such as knowing how to download and print a Davis Vision direct reimbursement claim form, can help alleviate some of these concerns.
Industry-leading security and compliance
US Legal Forms protects your data by complying with industry-specific security standards.
-
In businnes since 199725+ years providing professional legal documents.
-
Accredited businessGuarantees that a business meets BBB accreditation standards in the US and Canada.
-
Secured by BraintreeValidated Level 1 PCI DSS compliant payment gateway that accepts most major credit and debit card brands from across the globe.