Get Vision Care Prior Authorization Form Page 1 Of 1

Filling out the Vision Care Prior Authorization Form online is an essential process to ensure that necessary vision care services are approved efficiently. This guide aims to provide clear and supportive instructions for users to navigate through the form with ease.

Follow the steps to complete the Vision Care Prior Authorization Form online.

1. Press the ‘Get Form’ button to access the form and open it in your digital workspace.
2. Begin by entering the member information in the designated fields. Fill in the Member’s ID number, full name, and date of birth.
3. Next, complete the provider information section. Provide the provider’s name, Supplier ID or NPI number, date of request, group name, previous authorization number, date of service, phone number, fax number, and contact name.
4. Proceed to the clinical information section. Fill in the CPT codes, units, and diagnosis. Select the applicable lens options such as progressive lenses or other requests and provide rationale in the designated areas.
5. In the services requested section, check the relevant boxes for services like replacement lenses or contact lenses, and address the required conditions by selecting 'Yes' or 'No' where prompted.
6. Ensure that the form is signed by the treating physician and include the date of the signature.
7. Once all information is entered, review the form for accuracy. Save any changes, and then download, print, or share the form as necessary before submission to the Utilization Management Department.

Complete your forms online today for quicker processing and efficient vision care service approvals.