Get Blue View Visionsm Reimbursement Form / / / / - Benefits Pnnl

Completing the Blue View VisionSM Reimbursement Form online can streamline your request for reimbursement for vision services. This guide provides step-by-step instructions to ensure you fill out the form accurately and completely.

Follow the steps to successfully complete your reimbursement form.

1. Click ‘Get Form’ button to access the reimbursement form and open it in your document editor.
2. Complete the 'Patient Information' section by entering your first name, last name, middle initial, street address, city, state, phone number, and birth date. Ensure all information is accurate.
3. Fill out the 'Plan Information' section with the subscriber's name, first name, last name, middle initial, plan name, and subscriber ID. Verify that this information matches your insurance documents.
4. In the 'Request for Reimbursement' section, indicate the amounts charged for the services, including exams, frames, lenses, and contact lenses. Attach itemized receipts to support your claims.
5. Select the type of lenses purchased by checking the appropriate box for single, bifocal, trifocal, or progressive lenses.
6. Review the certification statement regarding the accuracy of the information you have provided. Sign and date the form in the indicated area.
7. Send your completed form and attached receipts to Blue View Vision via fax, email, or mail, based on your preference.

Ensure to complete your Blue View VisionSM Reimbursement Form accurately and submit it online for prompt processing!