superior vision reimbursement

Our vision providers can access the following tools to help them provide efficient and quality care. If you disagree with the decision or explanation given to you by the Customer Service Representative or if you have a complaint about any other issue regarding your insurance, you may request a grievance review. If at the conclusion of the formal appeal process Superior Vision denies the appeal and Superior Vision does not initiate the external independent review process, Superior Vision shall provide the member with notice of option to proceed to an external independent review. You may email us the completed forms or bring them with you on your next visit.. But for anti-scratch coating, you only get discounts. You may have an interpreter made available to you free of charge to facilitate your conversation with your eye care professional or Superior Vision. Envolve Vision provides expert eye care benefit services for Medicaid, Medicare, and Health Insurance Marketplace member products with more than 30 years of experience operating as a full-service, eye care speciality Health Management Organization (HMO). professionals who participate in your plan. Thank you. Tenemos intrpretes en espaol, chino, vietnamita, tagalo y coreano. Download the data file or print your PDF version. De esta manera y totalmente libre de cargo tendr a su disposicin un intrprete que habla su propio idioma, mismo que facilitara su conversacin con su proveedor de cuidado de ojos o con Superior Vision. Your eyes deserve the best care from LASIK specialists you can trust. Provides free language services to people whose primary language is not English, such as: Operating System: Any version of Microsoft Windows family of operating systems. This site, its services and content do not constitute the practice of any vision care, medical, or other professional health care advice, diagnosis or treatment. Superior Vision's SmartAlert Wellness Program fosters communication between you, your eye care provider, and your primary care physician or . This browser accessible interface can be used to manage your site. Box 967 Rancho Cordova, CA 95741 Fax: 916.852.2277. Eliminate the routine and produce paperwork online! However, on December 15, 2016, HHSC is changing its Medicaid fee schedule for therapy services. Superior Vision has provided partnership opportunities for diverse suppliers in the following areas, including, but not limited to: All information presented on the Superior Vision website is provided solely for general consumer understanding and education. Try to make your search more narrow by adding other information to the search. To enable us to maintain our strong quality assurance and improvement standards, Superior Vision has a formal grievance policy and procedure. If you don't have a Cigna Vision account, register and log in to see a list of Cigna Vision Network eye care. To request a formal grievance review you have three options. 4. You may also fax it to us at (888) 343-3475 or email at CAG@versanthealth.com. Rehabilitation Act. It starts with our network. The availability, delivery, or quality of vision care services; Claims payment, handling, or reimbursement for vision care services; or. Providers must use the appropriate Current Procedural Terminology (CPT 1) codes or Healthcare Common Procedure Coding System (HCPCS) codes when submitting claims for vision services to the IHCP. The Superior Vision insurance customer service phone number is 1-800-507-3800. Our site makes use of cookies. For a complete list of modifiers, refer to the Modifiers: Approved List section in this manual. Superior Vision Plan offers one of the largest networks of vision care providers. Users of this website use links to other websites at their own risk. The member shall mail a written appeal to Superior Vision within sixty (60) days after receipt of the adverse decision. Denial reversed If we agree that the covered services should have been provided, or that the claim should have been paid we will authorize the service or pay the claim. In addition to the information below, you can email our privacy officer at. (20-2535 Expedited medical review; expedited appeal) not applicable. The health care insurer shall provide any service or pay any claim determined to be covered and medically necessary by the independent review organization for the case under review regardless of whether the judicial review is sought. If you need help understanding the language being spoken, Superior has people who can help you on the phone or can go with you to a medical appointment. For immediate situations where a member may have lost or damaged his or her contact lenses or eyeglasses and the member is out-of town, a customer service representative may facilitate directing the member to a contracted provider in the area. Vision Use professional pre-built templates to fill in and sign documents online faster. Here you will be free to change your password to whatever you like and of course maintain file management. The time frame to complete our review may be extended if we and you agree additional time is required to fully investigate and respond to the Grievance. LASIK surgery has been FDA-approved since 1995, and is performed to correct nearsightedness, farsightedness, and astigmatism. As this website contains links to other websites, Superior Vision makes no guarantee as to the content found on other sites. Pages are designed to avoid causing the screen to flicker with a frequency greater than 2 Hz and lower than 55 Hz. Superior Vision Services, Inc. Attn: Claims Processing P.O. Superior Vision is a registered trademark of Versant Health Holdco, Inc. AbileneTexas Midwest Eyewww.txmidwesteye.com(325) 670-3937, AustinEye Physicians of Austinwww.eyephysiciansofaustin.com(512) 583-2020, Dallas / Ft. WorthUT Southwestern Medical Center Laser Center for Vision Carewww.utswlasik.com(888) 663-2020, GalvestonUTMB Health Eye Centerwww.utmbeyecenter.com(281) 687-7022, HoustonUT Houston Medical Center Robert Cizik Eye Clinicwww.cizikeye.org(713) 559-5200, LubbockTexas Tech Laser Vision Institute(806) 743-7777, TylerEyeCare Associates of East Texaswww.eyecaretyler.com(903) 595-0500. Subscriber Information Please print clearly Subscriber Name Daytime Phone Evening Phone Mailing Address City State Name of Employer Zip Patient Information Patient Name Date of Birth Authorization Number Full Time Student Yes // No Verification may be required Claim Information Single Vision Lenses Bifocal Lenses Progressive Lenses Date of Service Exam Frame Is the provider an in-network provider Provider Name Contacts Contact Lens Fitting Exam Extra Ad-Ons Other Phone Number If you saw an in-network provider Are you applying for reimbursement after using an in-store sale or promotion you pay in full and then submit your receipt to Superior Vision for reimbursement at the out-of-network rates. Tambin podemos proporcionarle material en espaol acerca de sus beneficios. Box 791Latham, NY 12020. View Top 10 List To protect your account data in the unlikely chance of a system compromise, the website does not maintain a live connection to the main benefits system. Superior Vision is part of the MetLife family of companies. Pursuant to the requirements of this, Superior Vision shall select the provider physician or other health care professional who shall review the appeal and render the decision. If you do not already have a screen reader on your computer, there are free screen readers available online such as the open source NVDA screen reader. As a result it may not always be 100% up-to-date. CMS-1500 forms can be purchased at local office supply stores or by calling the U.S. Government Printing Office at (866) 512-1800. For Urgent medical conditions, members are instructed to contact their Medical Plan or Provider or local UCC. Neither Superior Vision nor the Insurer shall discontinue coverage for or otherwise penalize any covered person or provider for exercising his or her right to file a complaint or grievance. At Superior Vision, our benefits management tools are made available over the internet through a Web browser. After a decision is made pursuant to sections E, F, G or K, the reconsideration, appeal and administrative processes are completed and the departments role is ended, except: A decision made by the director or an independent review organization pursuant to this section is admissible in proceedings involving a health care insurer or Superior Vision. Effective for dates of service on or after September 1, 2019, the Medicaid-implemented fee schedule changes for Medicaid services are listed below. Registration reminder - you can register to view your personal coverage. Learn More About Individual Plans. As some content on this site is provided by other organizations and content providers, Superior Vision cannot and does not guarantee the accuracy, timeliness and/or source of information from these organizations. If Superior Vision concludes that the covered service should be provided or the claim for a covered service shall be paid, the health insurer (NGLIC) is bound by Superior Visions decision. Except as provided in section K. (below) within sixty (60) days after the member receives written notice by Superior Vision of the adverse decision, if the member decides to initiate an external independent review, the member shall mail to Superior Vision a written request for an external independent review, including any material justification or documentation to support the members request for the covered service or claim for a covered service. Superior Vision Reimbursement Form Online Get Superior Vision Reimbursement Form Online How It Works Open form follow the instructions Easily sign the form with your finger Send filled & signed form or save superior vision reimbursement rating 4.8 Satisfied 49 votes We apologize for the delay and appreciate your patience while we resolve the issues. We do this through a broad-based provider network comprised primarily of board-certified ophthalmologists (MD) complemented by optometrists (OD), opticians, and optical companies who are responsible for delivering quality services. Denial upheld If we continue to agree that the covered services or claim for a covered service should have been denied, the complainant will receive a written notice of that decision. Member Reimbursement Claim Form. Depending on your benefit coverage, a LASIK discount or allowance may be included. Superior Vision is a registered trademark of Versant Health Holdco, Inc. Superior Vision is a product offering from Versant Health, a company forged from the experience of two leading vision care plans. Site - Document Library. Wellness Center Vision Plan Out-of-Network Claim Form Please return this form with a copy of your paid, itemized receipt to: UnitedHealthcare Vision ATTN: Claims Department P.O. CLAIM ONLINE Members can submit an out-of-network claim through the secure Member Portal on SuperiorVision.com. Users should not delay in contacting a vision/eye care professional based on information they have obtained from this site, or any site whose link may be found on the Superior Vision website. For more insight about website accessibility visit the Web Accessibility Initiative website. Moreover, you get full coverage for lenses, including polycarbonate. USLegal has been awarded the TopTenREVIEWS Gold Award 9 years in a row as the most comprehensive and helpful online legal forms services on the market today. Accessibility Statement - Privacy Policy - Sitemap. Mail or fax a copy of the itemized invoice or receipt imprinted with the provider s name and address along with this form to the contact information below. Member Reimbursement Claim Form Use this form for reimbursement for services received from an out-of-network provider, or when you ve utilized an in-store . Download Form OptumHealth Vision / United Healthcare. Superior Vision is a product offering from Versant Health, a company forged from the experience of two leading vision care plans. If you are looking for an eye doctor or need assistance in choosing one nearest you, you may call the customer service toll-free telephone number shown on your ID card, or visit the Superior Vision Services website: superiorvision.com. You can also request any materials on this website in another format, such as large print, braille, CD or in another language. 2022 Versant Health Holdco, Inc. (Versant Health). Callers may experience longer-than-usual wait times. Use this form for reimbursement for services received from an out-of-network provider, . Structural markup to indicate headings and lists (semantics) to aid in page comprehension. Please review your schedule of benefits to determine if you have a LASIK allowance included in your vision benefit plan. Members should not delay in contacting a vision/eye care professional based on information they have obtained from this site, or any site whose link may be found on the Superior Vision website. Declaracin de Privacidad en Espaol esta aqu. This policy is for when members have questions or concerns about the quality of vision care that they receive, or have an issue with a claim. Once your request is received, we will research the case in detail, ask for more information as needed and let you know, in writing, of the decision or the outcome of the investigation into your case. 2022 Superior Vision. Any proceedings before the office of administrative proceedings that involve an expedited external independent review and that are subject to section K (above) shall be promptly instituted and completed. It has full administrative capabilities and will allow you to set preferences. Out-of-network co-pays will be deducted from the out-of-network reimbursement. You do not need to fill in all blanks. Method to skip repetitive navigation links. Details of the attempt that was made to resolve the problem. Disclaimer: Versant Health, Inc.s and each of its subsidiaries (together, Versant Healths) policies and procedures (P&Ps) are confidential and proprietary, and are subject to change at any time. The name and identification number of the member asking for the review; Names of health care providers or administrative staff involved; and. Superior Vision contracts with various LASIK networks. Superior Vision Services, Inc. Notice of Privacy Practices, Superior Vision Services, Inc. Privacy Notice, Superior Vision of Texas Notice of Privacy Practices, Superior Vision of New Jersey, Inc. Notice of Privacy Practices, Superior Vision of New Jersey, Inc. Privacy Notice, Superior Vision Insurance Plan of Wisconsin, Inc. Notice of Privacy Practices, Superior Vision Insurance Plan of Wisconsin, Inc. Privacy Notice, Superior Vision Benefit Management, Inc. Notice of Privacy Practices, Superior Vision Benefit Management, Inc. Privacy Notice, Superior Vision Services, Inc. Notice of Privacy Practices New York, Superior Vision Services, Inc. Privacy Notice New York, https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, http://www.hhs.gov/ocr/office/file/index.html, Medicare, Medicaid, CHIP, Tricare, Health Insurance Marketplaces, Language Assistance Program, Language Assistance: Espaol | | Ting Vit | | Tagalog | | | Deutsch | | | Other Languages, Address of eye care professional (street, city, state). Cookies are used for the following purposes: As part of our effort to provide Superior Service, we strive to make our products and services accessible to all users, including individuals with disabilities. Except as provided in section K of this section, for cases involving an issue of coverage, within fifteen (15) business days after receipt of all of the information prescribed in section C (above) from Superior Vision, the director shall determine if the service or claim is or is not covered and if the adverse decision conforms to Superior Visions utilization review plan and this article and shall mail a notice of determination to Superior Vision, the health insurer, the member and the members treating provider. How do I find a network provider? Vision insurance is issued by Metropolitan Life Insurance Company, New York, NY. In the event of a denial of a claim for a service that has already been provided, the member may request, either orally or in writing, an informal reconsideration by notifying Superior Vision within two (2) years after the receipt of the notice of denial. Department at 1-800-507-3800 for information regarding your reimbursement. If you are a group that wants to participate in the file exchange program you will need to fill out online request form and submit it to the IS Department at Superior Vision Services for review. It contains important information about your vision plan and your right to contest a claim decision or file a Grievance. Subscriber Information Please print clearly Subscriber Name Daytime Phone Evening Phone Mailing Address City State Name of Employer Zip Patient Information Patient Name Date of Birth Authorization Number Full Time Student Yes // No Verification may be required Claim Information Single Vision Lenses Bifocal Lenses Progressive Lenses Date of Service Exam Frame Is the provider an in-network provider Provider Name Contacts Contact Lens Fitting Exam Extra Ad-Ons Other Phone Number If you saw an in-network provider Are you applying for reimbursement after using an in-store sale or promotion you pay in full and then submit your receipt to Superior Vision for reimbursement at the out-of-network rates. Date: 10/01/19. These exams promote early detection and treatment of chronic conditions. The user-friendly drag&drop graphical user interface allows you to add or relocate areas. These P&Ps are not all-inclusive, but contains general information that applies to many, but not all, employer group health plans administered by Versant. Billing and Reimbursement for Vision Services . Superior Vision. Superior Vision is a vision insurance company focused on providing quality eye care and treatment, rather than simply offering savings on eyewear. Contact your Medical Plan if you have questions concerning coverage for treatment of a medical or ophthalmologic condition. 2. Personal Attendant Services. If you encounter a PDF that you cannot read, please contact us. We test content for accessibility during production and are constantly working to improve our website accessibility. Reimbursement will be sent to the Plan subscriber (see Help Sheet for definition) at the address Ambetter from Superior HealthPlan has on record (To view your address of record, please log on to Ambetter.SuperiorHealthPlan.com or call Member Services at 1-877-687-1196 (TDD/TTY: 1-800-735-2989). Related. Enjoy smart fillable fields and interactivity. Contact Us. The independent review organization, the director or the office of administrative hearings may not order the health care insurer to provide a service or to pay a claim for a benefit for a service that is excluded from coverage by the contract. For more information, please review the following article: Therapy Fee Schedule Reimbursement Rates. Main page content Document File(s) Superior Vison Claim Form. Serious dysfunction of any of the members bodily organs or parts. Some states require a specific grievance policy and procedure. We apologize for the delay and appreciate your patience while we resolve the issues. See the Future with Envolve Vision. Customer service representatives are trained to respond to calls quickly, resolve problems promptly and exercise sensitivity. In order to obtain password, requestor must call 1 (800) 923-6766 (extension 2230). Within five (5) business days after receiving a notice of decision from the independent review organization, the director shall mail a notice of the decision to Superior Vision, the health insurer, the member and the members treating provider. A cookie is an element of data that a website can send to your browser, which may then store it on your system. Guarantees that a business meets BBB accreditation standards in the US and Canada. Refer to your schedule of benefits, to see what your vision plan provides. To submit a practitioner application to CAQH, go to the CAQH website. CareSource PASSE covers vision services for our members. . Birmingham, AL 35238-5018. Superior Vision Attn: Claims Processing P.O. To proceed with learning more about Versant Health, please click on the button below. We can also provide member benefits materials to you in Spanish. All rights reserved. Superior Vision has adopted the following Priority 1 Checkpoints of the Web Content Accessibility Guidelines 1.0 (WCAG 1.0) (May 5 1999) published by the Web Accessibility Initiative of the World Wide Web Consortium: 1.1, 1.4, 2.1, 6.1, 1.2, 9.1, 5.1, 5.2, 12.1, 7.1, 11.4 as our website accessibility standard and are working to ensure that our website complies with that standard, as well as Section 508 of the U.S. Organs or parts Vision, our benefits management tools are made available to you in Spanish stores or calling. En espaol acerca de sus beneficios was made to resolve the issues appeal ) not applicable your., refer to your browser, which may then store it on your next visit ) 343-3475 or at! Use this Form for reimbursement for services received from an out-of-network provider, to submit a practitioner application to,. Number of the members bodily organs or parts in your Vision Plan and your right to contest a decision... 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