Say Hello to the Brandnew Davis Vision Mobile App TeamstersCare 25
Davis Vision Claim Form. Box 791 latham, ny 12110 fax: 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
Be sure to keep a copy for your records. Each patient’s services must be claimed on a separate form. (choose one) ☐member ☐spouse ☐domestic partner. Please submit to the following contact: Be sure that all sections have been completed and that you and the provider(s) have. Follow the instructions on the form to submit your claim. Only services listed on this form will be considered for reimbursement. Box 791 latham, ny 12110 fax: Web davis vision has been providing comprehensive vision care benefits for over 50 years. Use this form to request reimbursement for services received from providers who do not participate in the davis vision network.
Expenses for both examinations and eyewear can be claimed on this form. Web vendor maintenance request form (excel) additionally, ensure you include the following: You must include either your eye care professional’s signature or a detailed receipt. Davis vision complaints and appeals department p.o. Expenses for both examinations and eyewear can be claimed on this form. 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. Each patient’s services must be claimed on a separate form. Use this form to request reimbursement for services received from providers not in the davis vision network. If a corrected claim has been attached, please specify revisions that were made: Expenses for both examinations and eyewear can be claimed on this form.
