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FOR OFFICE USE ONLY VISION CLAIM FORM Claims Processing Unit P.O. Box 6927 Columbia, SC 29260 Before completing this form, see reverse for instructions. Use a separate claim form for each patient.

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Feel all the key benefits of submitting and completing documents online. Using our platform submitting PAI Vision only takes a few minutes. We make that possible by offering you access to our full-fledged editor effective at changing/fixing a document?s initial textual content, inserting special boxes, and e-signing.

Execute PAI Vision in a couple of clicks by simply following the recommendations below:

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  3. Complete the necessary fields (they will be yellowish).
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  7. Press Done and download the ecompleted template to the device.

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