Get Pai Vision

Filling out the PAI Vision form online can be streamlined and efficient with the right guidance. This guide provides detailed instructions to help users complete each section of the form accurately.

Follow the steps to successfully fill out the PAI Vision form.

1. Press the ‘Get Form’ button to access the form and open it in the online editor.
2. Enter the member’s identification number exactly as it appears on the identification card.
3. Fill in the member’s first name and last name, ensuring that no nicknames are used.
4. Provide the home telephone number, including the area code.
5. If the member has a new address, check the corresponding box and fill in their complete mailing address, including street, apartment number, city, state, and zip code.
6. Input the patient’s name, including their first name, middle initial, and last name.
7. Fill in the patient’s birthdate in the format of month, day, and year.
8. Select the patient’s sex by checking the appropriate box.
9. Indicate the relationship of the patient to the member by checking the applicable box.
10. Describe the diagnosis or condition requiring treatment in detail.
11. If the treatment was a result of an accidental injury, select 'Yes' or 'No' and provide details if applicable.
12. Indicate whether the injury or illness was work-related and if a Workers Compensation claim was filed.
13. Complete the Medicare coverage section if the patient is covered by Medicare, entering Part A and Part B numbers if applicable.
14. If the patient is covered under other group health insurance, provide all required details.
15. For procedure codes, enter the necessary codes as specified in the form based on the provided medical services.
16. Fill out the lines for the provider's name, service details, charges, and ensure all required signatures are obtained.
17. After completing all fields and reviewing the information, users can save changes, download, print, or share the completed form.

Complete your PAI Vision form online today for a seamless claim process.