Department at 1-800-507-3800 for information regarding your reimbursement. Learn more about LASIK. If you see an in-network provider but choose to take advantage of a sale, coupon, or other in-store special, the provider may require that you pay in full and then submit your receipt to Superior Vision for reimbursement at the out-of-network rates. You will need to contact Superior Vision Customer service at 1-800-507-3800 to obtain an authorization number prior to using your out-of-network benefits. If you see an in-network provider but choose to take advantage of a sale, coupon, or other in-store special, the provider may require that you pay in full and then submit your receipt to Superior Vision for reimbursement at the out-of-network rates. Service Department at (800) 507-3800 for information regarding your reimbursement. Hearing health care … Member Vision Claim Form Microsoft. You will need to contact Superior Vision Customer service at 1-800-507-3800 to obtain an authorization number prior to using your out-of-network benefits.

Eligibility and benefits should be verified with Superior Vision via our online provider portal, fax, or through our Customer Service department. Email: Customer Service. Superior Vision contracts with various LASIK networks. Coverage varies from group to group depending on the plan selected.

Contact ERS . You can get your FramesDirect.com purchase reimbursed by Superior Vision if out-of-network benefits are included in your plan. dental, vision) on the same form. No. Provider Name. Yes No . The Sun Life Indemnity PPO Dental plan includes a vision discount plan through Vision Service Plan (VSP). Network providers are available in all 50 states.
Medical Claim Form Direct Member Reimbursement Request. Davis Vision/ Superior Vision will follow telemedicine reimbursement policies for state jurisdictions where we do business. Mark C. Ruchman MD .
Comment. After trying to contact them for several days, they finally returned our calls and stated that we would have to go though he re credentialing process and the plan has now changed to Davis Vision.

Superior Vision provides routine PPO vision care plans to employers for the benefit of their employees. You can review your benefits here or by calling 1-800-507-3800. Is the provider an in-network provider? Are you applying for reimbursement after using an in-store sale or promotion? Member Reimbursement Claim Form - Superior Vision.

0 Downloads 32 Views. 4. Medical Claim … PREFERRED DRUG LIST. 5. The Network Provider will bill Superior Vision directly for all covered services. The Network Provider will bill Superior Vision directly for all covered services. Yes No . Are you applying for reimbursement after using an in-store sale or promotion? Superior Vision Attn: Claims Processing P.O. State of Texas Vision c/o Superior Vision, Administrators Attn: Claims Processing 11090 White Rock Road Suite 175 Rancho Cordova, CA 95670.

erscontact@superiorvision.com. VSP is available for you and everyone covered on your dental plan! Eye exams. Complete a separate NIHB Client Reimbursement form for each eligible client and type of benefit.

If your current eye care professional is not listed, you can request that they be added to the network by submitting a provider nomination form or by calling Superior Vision Customer Service at (877) 396-4128. Retain a copy of all receipts and documentation for your records. If you answered no to question 2, please note Superior Vision Network Providers should only collect for Co-payments and/or Non-Covered items at the time of service. Davis Vision/ Superior Vision will follow telemedicine reimbursement policies for state jurisdictions where we do business.

Describe Superior Vision’s role as an administrator of vision care plans, and specify the potential client groups that the practitioner would serve.

No .

Comments.

Subscriber Information Last … These relate to Medicaid and commercial populations. Depending on your benefit coverage, a LASIK discount or allowance may be included. If you see an in-network provider but choose to take advantage of a sale, coupon, or other in-store special, the provider may require that you pay in full and then submit your receipt to Superior Vision for reimbursement at the out-of-network rates. The Network Provider will bill Superior Vision directly for all covered services.

Please do not include different types of benefits (e.g. If you answered No to question 2, please note Superior Vision Network Providers should only collect for Copayments and/or Non-covered items at the time of service. Are you applying for reimbursement after using an in-store sale or promotion? Your session will end in 60 seconds. Yes. 4. In most cases, LASIK is performed on both eyes and completed within minutes.

Except as noted by federal waivers, reimbursement policies for dual eligible members will be governed by federal policy. Mark C. Ruchman MD . Member Reimbursement Claim Form Use this form for reimbursement of services received from an out-of-network provider, or when you have utilized an in-store sale or promotion from an in-network provider. Except as noted by federal waivers, reimbursement policies for dual eligible members will be governed by federal policy. Download PDF.