Get Services Overview - College Of Education - The University Of...

Completing the out of network vision services claim form is essential for receiving reimbursement for your vision care services. This guide provides clear and instructive steps to help you accurately fill out the form online and ensure a smooth claims process.

Follow the steps to accurately complete the claim form.

1. Locate and press the ‘Get Form’ button to obtain the out of network vision services claim form and open it in your online editor.
2. Fill in all patient and subscriber information, including names, birth dates, member IDs, and addresses for both the patient and the subscriber as required.
3. Provide the name of the doctor or store where the services were received, along with the date of service in the required format (MM/DD/YYYY).
4. Enter the vision plan name and group number as indicated on your benefit ID card.
5. List the services received by checking the appropriate boxes and entering the amount charged for each service, ensuring to include your itemized paid receipts.
6. Sign the claim form at the designated area, certifying that the information provided is true and complete.
7. Submit the completed form and itemized receipts to First American Administrators at the address specified in the form. Be sure to do this within fifteen (15) months from the original date of service.
8. After submission, allow at least 14 calendar days for claim processing. You will receive your reimbursement check or explanation of benefits in the mail within seven (7) calendar days of processing.

Complete your out of network vision services claim form online today to ensure you receive your eligible benefits.