Davis Vision Claim Form. Web log in to your account and click on “access benefits and forms” to download the direct reimbursement claim form. Only services listed on this form will be considered for reimbursement.
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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. Each patient’s services must be claimed on a separate form. 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. Expenses for both examinations and eyewear can be claimed on this form. Use this form to request reimbursement for services received from providers not in the davis vision network. Web davis vision by metlife member reimbursement form. Davis vision is a separate company that performs claims administration for your vision program. Only services listed on this form will be considered for reimbursement.
If a corrected claim has been attached, please specify revisions that were made: Web log in to your account and click on “access benefits and forms” to download the direct reimbursement claim form. Client / group name the request is regarding; Box 791 latham, ny 12110 fax: Web direct reimbursement claim form important information: This change aligns davis vision and superior vision with cms guidelines on paper claims submission. Web davis vision by metlife member reimbursement form. Use this form to request reimbursement for services received from providers who do not participate in the davis vision network. Letter of authorization from client / group; Use this form to request reimbursement for services received from providers who do not participate in the davis vision network. Only services listed on this form will be considered for reimbursement.
