Get 837p Vision (pdf) - Dhs State Mn

This guide provides a comprehensive overview of how to complete the 837P Vision form for claims related to vision care and eyeglasses. By following the detailed steps outlined, users can ensure an accurate and efficient submission process.

Follow the steps to successfully complete your 837P Vision claim form.

1. Press the ‘Get Form’ button to access the 837P Vision form and open it in your preferred PDF viewer.
2. Begin by filling out the Subscriber tab. Enter the recipient's information, including their member number from the MHCP identification card, along with their birth date, last name, first name, gender, street address, city, state (MN), and zip code.
3. Proceed to the Providers tab by selecting the information related to the billing provider. Most fields will auto-populate based on your file. If required, enter the information of any additional providers that performed or ordered the service.
4. Move to the Coordination of Benefits (COB) tab. If there are other payers, such as Medicare, gather the necessary information from their EOBs and complete the fields regarding third-party liability or other applicable insurance.
5. Next, fill out the Claim Information tab. This includes essential details about the claim level information, such as place of service, patient account number, and diagnosis codes. Ensure all mandatory fields are accurately completed.
6. Complete the Services tab by entering the date services were provided, procedure codes, and any applicable modifiers. Include charges for the services and ensure all required fields are filled.
7. Validate your claim by clicking the Validate button to check for any missing or incorrect information. Make necessary corrections based on the validation response.
8. Finally, submit your claim by clicking the Submit button. You will receive a Claim Response indicating the successful submission of your claim.

Complete your 837P Vision claim form online today to ensure timely processing and reimbursement.