Get Uaw-gm - Davis Vision

This guide provides a detailed overview of how to accurately complete the UAW-GM - Davis Vision form for Laser Vision Correction reimbursement. Following these instructions will help ensure your submission is complete and processed efficiently.

Follow the steps to successfully complete the form.

1. Click ‘Get Form’ button to access the form and open it in the editor.
2. Complete the Member/Employee Information section. Ensure to provide your member name, identification number, mailing address, and contact information. Use clear print for easy readability.
3. In the Patient Information section, fill in the patient’s name, confirmation number, relationship to the member, and date of birth.
4. Complete the Provider Information section with the surgeon or facility’s name, address, federal tax identification number, and phone number. Ensure the provider signs the form.
5. Fill in the Service section with the date of service and related amounts for each procedure performed, including initial evaluation, procedures for both eyes, and follow-up.
6. In the Member Certification section, read and understand the certification statement. Sign and date the form to certify that the information you provided is correct.
7. Once all sections are complete, attach a copy of the bill from your provider, and ensure all signatures are in place.
8. Finally, review the entire form for accuracy before submitting it. You can then save changes, download the document, print it, or share it as needed.

Take action now by completing the UAW-GM - Davis Vision form online to ensure your claim is processed swiftly.