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Get Eyemed Medically Necessary Contact Lens Claim Form 2013-2025
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How to fill out the EyeMed Medically Necessary Contact Lens Claim Form online
Filling out the EyeMed medically necessary contact lens claim form online can seem daunting, but with clear instructions, you can complete it efficiently. This guide provides a step-by-step approach to ensure you correctly fill out each required section of the form.
Follow the steps to complete the claim form accurately.
- Click ‘Get Form’ button to initiate the process and access the form in the designated editor.
- Begin by filling out the patient information section. Include the patient’s last name, first name, street address, city, and date of birth in MM/DD/YYYY format. Ensure the telephone number includes the area code, and if applicable, provide the member ID.
- Indicate the relationship to the subscriber by selecting one of the options: self, spouse, or child. Also, fill in the patient’s middle initial, state, and zip code.
- Next, fill out the subscriber information section, which includes the same fields as the patient information: last name, first name, street address, city, date of birth, and telephone number with area code.
- Provide the vision plan name and vision plan/group number, along with the date of service required in MM/DD/YYYY format and possibly an authorization number.
- In the medically necessary codes section, check all applicable boxes that correspond to the final prescription as outlined in the EyeMed Professional Provider Manual. Ensure to document the ICD-9 codes and usual and customary amounts charged.
- If the claim is for pediatric vision benefits specific to California, complete the additional section for pediatric aniridia and pediatric aphakia, providing the applicable codes and charges.
- Complete the request for material reimbursement section by entering the U&C amount charged for each item.
- Review the important information provided to ensure compliance with the claims process and avoid any inaccuracies that may lead to penalties.
- Once all sections are completed, review the entire form for accuracy. You can then save changes, download, print, or share the form for submission.
Take action now and complete your EyeMed Medically Necessary Contact Lens Claim Form online.
The contact lens code used in optometry typically refers to the specific billing code that eye care professionals use for reimbursement. This code can vary based on the type of lens and the patient's condition. Ensure your eye care professional provides the correct code when you are filling out your EyeMed Medically Necessary Contact Lens Claim Form.
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