Loading
Get Davis Vision Direct Reimbursement Claim Form 2012
How it works
-
Open form follow the instructions
-
Easily sign the form with your finger
-
Send filled & signed form or save
How to fill out the Davis Vision Direct Reimbursement Claim Form online
This guide provides clear and supportive instructions for filling out the Davis Vision Direct Reimbursement Claim Form online. You will learn about each component of the form and the necessary steps to ensure accurate completion.
Follow the steps to complete your claim form effectively
- Click 'Get Form' button to obtain the form and open it for editing.
- Begin by filling in your member or employee information clearly. Include your full name, identification number, and mailing address in the specified fields. Ensure that all required sections are completed thoroughly.
- Enter your business and home phone numbers, using the appropriate area codes. This allows the processing unit to contact you if further information is needed.
- Provide patient information, including the patient’s name and their relationship to you. If the patient is a child and over the age of 19, attach written proof of their school attendance if required.
- Fill in the provider information for both the examiner and the dispenser. This includes their names, addresses, state license numbers, and phone numbers. Accurate details here help in verifying the services rendered.
- In the service section, list the date of service and the types of expenses incurred. Include all relevant items such as eye examinations, frames, and various lenses, ensuring that each item's cost is recorded correctly.
- Review all sections of the form for accuracy. Ensure that you and the provider have signed the document. Certification by the member/employee or an authorized person is necessary to validate the claim.
- Once the form is complete, save your changes. You may download, print, or share the form as needed to ensure you have a copy for your records.
Complete your Davis Vision Direct Reimbursement Claim Form online to facilitate timely processing of your reimbursement.
Get form
Experience a faster way to fill out and sign forms on the web. Access the most extensive library of templates available.
To submit for reimbursement with Davis Vision, you need to fill out the Davis Vision Direct Reimbursement Claim Form thoroughly. Attach the required documentation, such as receipts, to substantiate your claim. Once completed, send the form to the appropriate address outlined by Davis Vision for processing.
Get This Form Now!
Use professional pre-built templates to fill in and sign documents online faster. Get access to thousands of forms.
Industry-leading security and compliance
US Legal Forms protects your data by complying with industry-specific security standards.
-
In businnes since 199725+ years providing professional legal documents.
-
Accredited businessGuarantees that a business meets BBB accreditation standards in the US and Canada.
-
Secured by BraintreeValidated Level 1 PCI DSS compliant payment gateway that accepts most major credit and debit card brands from across the globe.