EyeMed Medically Necessary Contact Lens Claim Form 2013-2025 free printable template

Deemed 4000 Luxottica Place Cincinnati, OH 45040 Visit us online at www.eyemed.com Fax claim form to 866.293.7373 Medically Necessary Contact Lens Claim Form Provider Reimbursement Patient Information

How to fill out eyemed reimbursement form pdf

How to fill out EyeMed Medically Necessary Contact Lens Claim Form

1. Start by downloading the EyeMed Medically Necessary Contact Lens Claim Form from the EyeMed website.
2. Fill in your personal information at the top of the form, including your name, address, and contact details.
3. Provide your EyeMed member ID and the patient's date of birth if you are filling the form on behalf of someone else.
4. Indicate the type of lenses required and provide any necessary documentation or prescription from your eye care provider.
5. Complete the section for provider information if the lenses were obtained through an eye care professional.
6. Include any previous claims submitted that may relate to this request.
7. Sign and date the form, certifying that all information provided is correct and complete.
8. Submit the completed claim form along with any accompanying documents to EyeMed Claims Department via mail, fax, or online submission.

Who needs EyeMed Medically Necessary Contact Lens Claim Form?

1. Individuals who require contact lenses for medical reasons as determined by an eye care professional.
2. Patients with specific eye conditions that necessitate the use of medically necessary contact lenses.
3. Members of EyeMed insurance plans looking to file a claim for reimbursement for their medically necessary lenses.

People Also Ask about eyemed enrollment form

What is CPT code V2520?

HCPCS code V2520 for Contact lens, hydrophilic, spherical, per lens as maintained by CMS falls under Assorted Contact Lenses .

Does VSP cover medically necessary contacts?

The VSP integration allows you to create orders and submit VSP claims for medically necessary contact lenses. VSP requires that the patient's most recent eyeglass prescription be included when you create medically necessary contact lens orders.

How do I get my contacts deemed medically necessary?

The first step to know your candidacy for necessary contact lenses is to schedule an appointment with your eye doctor. At that time, you will learn about your treatment options and any potential out-of-pocket costs should you proceed forthwith contact lens treatment.

What is the CPT code for medically necessary contact lenses?

CPT code(s): 92310 (Prescription of Optical and Physical Characteristics of and Fitting of Contact Lens, with Medical Supervision of Adaptation; Corneal Lens, Both Eyes, Except for Aphakia)

How do I file medically necessary contacts with EyeMed?

Here's how it works Draw your signature, type it, upload its image, or use your mobile device as a signature pad. Send eyemed medically necessary contacts form 2019 via email, link, or fax. You can also download it, export it or print it out.

What is CPT code V2531?

V2531 Contact Lens, GP, Scleral, Per Lens Use this code when fitting scleral lenses (including corneo-scleral, mini-scleral, or full scleral). Do not use V2530, which is a scleral lens that is gas-impermeable.

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What is EyeMed Medically Necessary Contact Lens Claim Form?

The EyeMed Medically Necessary Contact Lens Claim Form is a specific form used to request reimbursement for contact lenses that are deemed medically necessary for the treatment of certain eye conditions.

Who is required to file EyeMed Medically Necessary Contact Lens Claim Form?

Individuals who have received medically necessary contact lenses and wish to seek reimbursement through their EyeMed insurance plan are required to file this form.

How to fill out EyeMed Medically Necessary Contact Lens Claim Form?

To fill out the form, provide personal information, details about the medical condition, and a prescription from a licensed eye care provider, along with any supporting documentation as required by EyeMed.

What is the purpose of EyeMed Medically Necessary Contact Lens Claim Form?

The purpose of the form is to facilitate the reimbursement process for patients who need contact lenses for medical reasons, ensuring that necessary expenses are covered by their insurance.

What information must be reported on EyeMed Medically Necessary Contact Lens Claim Form?

The form must include the patient's name, membership information, details of the eye condition, the prescribing doctor's information, and receipts or invoices related to the purchase of the contact lenses.