Follow the steps to complete your claim form successfully.

1. Press the ‘Get Form’ button to access the claim form and open it in your preferred online document editor.
2. Begin by filling in your claim number in the designated field at the top of the form.
3. Complete items 1 through 11 with all the requested information related to the subscriber and the claim, ensuring no fields are left blank to avoid any issues.
4. If applicable, fill in item 4 regarding any other health insurance coverage you may have for vision or eye care.
5. Provide your identification number in item 6 as it appears on your identification card or provide the subscriber's social security number.
6. Indicate the group number from your identification card in item 8.
7. If applicable, complete item 12 if you prefer to have benefits paid directly to your service provider.
8. The service provider must then complete items 13 through 36. Ensure that they fill out any required details including referrals and service specifics.
9. Check item 23 with the name of the referring provider or to whom you referred the patient.
10. In item 29D, specify the date of service, place of service, charges, and frequency as needed.
11. Ensure the provider fills in item 36, signing and dating the form if it is being used as a substitute for a detailed itemized bill.
12. Review all the filled information to ensure accuracy and completeness before submission. Keep a copy of the form for your personal records.
13. Submit the completed claim form via email, fax, or by mailing it to the appropriate address as indicated.
14. Once submitted, monitor your claim status as advised by your insurance provider.

Start filling out your KY Britcay Vision/Eye Care Claim Form online today to ensure your claim is processed smoothly.