Get Vision Claim Form - Anthem

This guide provides clear instructions on how to fill out the Vision Claim Form - Anthem online. By following the step-by-step process, you will be able to submit your claim accurately and efficiently.

Follow the steps to fill out the Vision Claim Form online.

1. Press the ‘Get Form’ button to acquire the Vision Claim Form and open it for editing.
2. Begin by entering the patient's name in the designated field, including their first name, middle initial, and last name.
3. Input the patient's date of birth in the appropriate section to ensure accurate identification.
4. Fill in the employee's address, including the street, city, state, zip code, and phone number. If there is a change in address, check the box provided.
5. Select the patient's sex by marking the correct box for either male or female.
6. Write the employee's name, including their first name, middle initial, and last name, in the specified field.
7. Enter the member ID number, ensuring it is accurate to prevent processing delays.
8. Describe the nature of the illness or injury, including the date of injury and how or where it occurred.
9. Indicate if the condition is related to the patient's employment, an auto accident, or another accident by checking the appropriate boxes.
10. Provide the spouse's employer's name and address if applicable.
11. Sign and date the form to authorize payment to the doctor or supplier and the release of medical information needed to process the claim.
12. Complete the sections designated for medical professionals, including their signature, details about the services provided, and associated charges.
13. Review the completed form for accuracy, then save changes, download, print, or share the form as needed.

Complete your Vision Claim Form - Anthem online today for a seamless claims process.