Say Hello to the Brandnew Davis Vision Mobile App TeamstersCare 25
Davis Vision Claim Form. Please submit to the following contact: Use this form to request reimbursement for services received from providers not in the davis vision network.
Say Hello to the Brandnew Davis Vision Mobile App TeamstersCare 25
Davis vision complaints and appeals department p.o. Box 791 latham, ny 12110 fax: Web direct reimbursement claim form important information: Expenses for both examinations and eyewear can be claimed on this form. (choose one) ☐member ☐spouse ☐domestic partner. Be sure to keep a copy for your records. This change aligns davis vision and superior vision with cms guidelines on paper claims submission. Davis vision is a separate company that performs claims administration for your vision program. Use this form to request reimbursement for services received from providers who do not participate in the davis vision network. You must include either your eye care professional’s signature or a detailed receipt.
Web direct reimbursement claim form important information: Davis vision is a separate company that performs claims administration for your vision program. You must include either your eye care professional’s signature or a detailed receipt. Web vendor maintenance request form (excel) additionally, ensure you include the following: Use this form to request reimbursement for services received from providers who do not participate in the davis vision network. Be sure to keep a copy for your records. Please submit to the following contact: Be sure that all sections have been completed and that you and the provider(s) have. Web direct reimbursement claim form important information: Web log in to your account and click on “access benefits and forms” to download the direct reimbursement claim form. This change aligns davis vision and superior vision with cms guidelines on paper claims submission.
