3. Ensuring members easy access to quality care with Superior Vision can help drive improvements in HEDIS/Stars scores. Your eyes deserve the best care from LASIK specialists you can trust. Box 1525 Latham, New York 12110 Superior Vision Claims Department P.O. ERISA provides that if your claim for a welfare benefit is denied, in whole or in part, you have the right to know why this was done, to obtain copies of all documents relating to the decision without charge, and to contest any denial, all within certain time schedules. Notwithstanding title 41 of the Arizona revised statutes, chapter 6, article 10 and section 12-908, if a party to a decision issued under this section seeks further administrative review, the department shall not be a party to the action unless the department files a motion to intervene in the action. As some content on this site is provided by other organizations and web content providers, Superior Vision cannot and does not guarantee the accuracy, timeliness and/or source of information from these organizations. See below for search help. Office Hours: 8:00 a.m. to 5:00 p.m. CST / 8:00 a.m. to 6:00 p.m. CST (STAR Health only) After office hours, Superior's STAR Kids nurse advice line staff is available to answer questions and intake requests for prior authorization by calling 1-844-590-4883. Effective for dates of service on or after September 1, 2019, the Medicaid-implemented fee schedule changes for Medicaid services are listed below. 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. To proceed with learning more about Versant Health, please click on the button below. The Exclusive Collection is a selection of stylish frames available to Davis . Employees Retirement System of Texas. Member Reimbursement Claim Form Use this form for reimbursement of services received from an out-of-network provider, or when . (20-2535 Expedited medical review; expedited appeal) not applicable. 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. These networks offer members a discount on LASIK services when using an in-network QualSight provider. Out-of-network co-pays will be deducted from the out-of-network reimbursement. If the members compliant is an issue of medical necessity under the coverage document and not whether the service is covered, a provider, physician, or other health care professional who is licensed pursuant to title 32 of the Arizona revised statutes, chapter 7,8,11,13,14,16,17,19 19.1, or 29 or an out of state provider physician or other health care professional who is licensed pursuant to title 32 of the revised Arizona statutes, chapter 7,8,11,13,14,16,17,19 19.1, or 29 or an out of state provider, physician or other health care professional who is licensed in another state and who is not licensed in Arizona and who typically manages the medical condition under appeal shall review the appeal and render a decision based on the utilization review plan adopted by Superior Vision. To zoom out press CTRL + MINUS SIGN (-). 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. Contact Us. Date: JavaScript and style sheets to enhance the appearance and functionality of the site. Products and Services From routine vision care to medical management, we offer distinct capabilities and flexible solutions. Author: A customer service representative will work with you to help you understand your coverage or resolve your problem or concern as quickly as possible. A grievance may be submitted to us by or on behalf of a covered person within 180 days of the date of treatment, event, or circumstance giving rise to the grievance, such as the date of the claim denial. information once your coverage begins. 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. If you paid in full for your service please provide a brief explanation as to why your provider did not bill us on your behalf. Because this site, and all content comprising the site, is for educational purposes only, there is nothing on the site that is or should be considered, or used as a substitute for, medical advice, including advice about vision and eye care and/or any issues related to vision and eye care. Who We Serve We are proud to serve over 38.5 million client members through our third-party government and health plan relationships. Superior Vision. All rights reserved. Superior National 01234601 Family Members PREF PLAN RM 10/30/30 FRAMES 130 FS9K 1/1/2018 View Benefits View Benefits View Benefits First Name: . Accessibility Statement - Privacy Policy - Sitemap. Vision - Active Employee. Your request for a grievance review should include: A Grievance may be submitted to us by or on behalf of a Covered Person within one year of the date of treatment, event or circumstance giving rise to the Grievance, such as the date of the claim denial. We reserve the right at any time and periodically to modify this site, temporarily or permanently, or any part thereof, with or without notice. Superior Vision shall mail a written acknowledgement to the member and the members treating provider within five (5) business days after Superior Vision receives the formal appeal. 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. . Internet Explorer: Select Tools > Internet Options > General dialog page, and the Colors button. 5. Superior Vision Services, Inc. administers this plan to provide access to our network of vision care providers. Learn More About QualSight LASIK University LASIK Specialists of Texas Your eyes deserve the best care from LASIK specialists you can trust. California Confidentiality of Medical Information. 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. As a participant in the plan you are entitled to certain rights and protections under the Employee Retirement Income Act of 1974 (ERISA). If the director finds that the case involves a medical issue or is unable to determine issues of coverage, the director shall submit the members case to the external independent review organization in accordance with section E (above) or K (below). If these technologies are not available, our page design helps ensure graceful degradation. If Superior Vision denies the members request for a covered service or claim for a covered service at Formal Appeal level, the member may initiate an external independent review. You may email us the completed forms or bring them with you on your next visit.. Superior Vision Information Sheet; Delta Dental. Box 967 We are currently experiencing technical issues impacting our service operations, including our member and provider portals. If Superior Vision initiates the external independent review process, Superior Vision does not have to comply with section E. (above). Call 1 (877) 201-3602 for a free LASIK consultation. As a result it may not always be 100% up-to-date. 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. You may also fax it to us at (888) 343-3475 or email at CAG@versanthealth.com. 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. After completing the claim form, you may attach your receipt (s) OR print and mail copies of your claim form and receipt (s) to: Vision Service Plan. Superior Vision automated phone service is available 24/7. We reserve the right at any time and periodically to modify this site, temporarily or permanently, or any part thereof, with or without notice. We collect Click-stream data, HTTP Cookies. Contact Information Fax: 855-313-3106Phone: 888-273-2121Email: ecs@superiorvision.comProvider Portal Superior Vision Provider Routine Vision References The Superior Vision (Versant) routine vision references provide information on topics . These exams promote early detection and treatment of chronic conditions. We will provide you and the provider furnishing the vision care services, if applicable, a written decision within thirty (30) calendar days following the request for a review. The preferred option is to send your grievance in writing to: Superior Vision Services, Inc.P.O. 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. I am . Download Form OptumHealth Vision / United Healthcare. Superior vision provides a $125- $200 frame allowance and covers in full single vision lenses, lined bifocals, and lined trifocals. We do not support any beta versions of Web browsers. Live customer service is available Monday through Friday from 8 a.m. to 9 p.m. and on Saturday from 11 a.m. to 4:30 p.m. Eastern time. We apologize for the delay and appreciate your patience while we resolve the issues. Our HIPAA Compliancy Statement can be found here. To proceed with learning more about Versant Health, please click on the button below. These P&Ps are not intended to dictate medical care decisions, and they do not and should not be interpreted as a substitute or replacement for a treating physicians prudent clinical judgment at the time vision services are delivered to a patient. However, with our preconfigured online templates, things get simpler. Superior Vision Services, Inc. u P.O. At Superior Vision, we offer patient forms online so you can complete them in the convenience of your own home or office. Superior Vision contracts with various LASIK networks. 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 . Vision coverage is available through the Superior Vision network for most plans. Moreover, you get full coverage for lenses, including polycarbonate. For a full copy of our policy, please click here to request it. SUPERIOR VISION See yourself healthy. WELCOME PROVIDERS. Box 967 u Rancho Cordova u California 95741 u 800-507-3800 u www.superiorvision.com . All information presented on the Superior Vision website is provided solely for general consumer understanding and education. When timed response is required, the user is alerted and given sufficient time to indicate more time is required. Contact Us | Find an Eye Care Professional | Disaster Relief. To proceed with learning about available career opportunities within Versant Health, please click on the button below. 200 East 18th Street Austin, TX 78701. All pages have page titles and title tags written for easy comprehension of the page content. Form fields with associated labels and error messages to assist with completing the form. Wellness Center Structural markup to indicate headings and lists (semantics) to aid in page comprehension. If there is every a question about accuracy, please contact us through the website or at (800) 507-3800. Many of the documents on this site are in PDF format. Customer service representatives are trained to respond to calls quickly, resolve problems promptly and exercise sensitivity. Superior Vision contracts with various LASIK networks. 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. Use your browsers print option. But for anti-scratch coating, you only get discounts. In the dialog box, select Content > Fonts & Colors. It is best viewed with Java Script enabled. You also may request additional cards by calling Superior Vision Customer Service at (877) 396-4128. You will need Adobe Reader to open PDFs on this site. Rehabilitation Act. Callers may experience longer-than-usual wait times. The preferred option is to send your Grievance in writing (company specific form is not required) to: If you choose you may fax it to us at: 916-852-2290, or. For more insight about website accessibility visit the Web Accessibility Initiative website. 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. To send a claim by paper, please mail claim forms to: Superior HealthPlan, Attn: Claims, P.O. These P&Ps are internal guidelines relating to Versant Healths role as an administrator for payors of vision benefit claims. You may email us the completed forms or bring them with you on your next visit. USLegal received the following as compared to 9 other form sites. Information is not shared with organizations not an entity of Superior Vision Services, its Web delivery partner, software vendors, brokers or service eye care specialists. Follow the simple instructions below: The preparing of legal documents can be costly and time-ingesting. Superior Vision is a Versant Health company. Some states require a specific grievance policy and procedure. Callers may experience longer-than-usual wait times. We will help you get the help you need. Personal Attendant Services. A practitioner will need to register as a first time user to get started. Please use the form below to request an appointment. Box 967 Rancho Cordova, CA 95741 Fax: 916-852-2277 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. Mac OS: To zoom in press COMMAND + PLUS SIGN (+). 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. Provides free aids and services to people with disabilities to communicate effectively with us, such as: Written information in other formats (large print, audio, accessible electronic formats, other formats). 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. Call Superior Vision Customer Service at (800) 507-3800, and someone who speaks your language can help you. If you do not already have AdobeReader installed on your computer, Click Here to download. Guarantees that a business meets BBB accreditation standards in the US and Canada. The Superior Vision Plan is a vision care program designed to offer a high-level of vision care to you and your family. Except as provided in section K, within five (5) days after the director receives all of the information prescribed in section C, the director shall choose and independent review organization and forward to the organization all of the information required by section C. Except as provided in section C (above) for cases involving an issue of medical necessity under the coverage document, within twenty-one (21) days after the date of receiving a case for independent review from the director, the independent review organization shall evaluate and analyze the case and, based on all information required under section C (above) render a decision that is consistent with the utilization review plan on whether or not the service or claim for the service is medically necessary and send the decision to the director. Tambin podemos proporcionarle material en espaol acerca de sus beneficios. #1 Internet-trusted security seal. Log on to www.myCigna.com. Ifyou believe that this page should betaken down, please follow our DMCA take down process, Ensure the security ofyour data and transactions, Superior Vision Reimbursement Form Online, TRIGONOMETRI EQUATIONS PART 1 Of 1.MDI - Teko Classes Bhopal, Stokes Stitt Scholarship Program - The Reading Housing Authority, ASITIA Permission Letter - Rutherford County Schools - Blm Rcs K12 Tn, Botswana Public Officers Pension Fund Forms. Declaracin de Privacidad en Espaol esta aqu. professionals who participate in your plan. 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. This site and all content comprising the site, is for educational purposes only and is not a substitute for professional medical advice or vision health care. The name and identification number of the member asking for the review; Names of health care providers or administrative staff involved; and. Superior Vision: The Superior Vision supplier diversity program is a good faith sourcing effort designed to match qualified diverse suppliers with the needs of our internal business partners, create business opportunities for diverse suppliers to support Superior Vision, and build long-term business relationships with individuals that are reflective of our communities. Use this form for reimbursement for services received from an out-of-network provider, . The Superior Vision Plan is a vision care program designed to offer a high-level of vision care to you and your family. 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. Aperture (the CVO services provider) will assist with a provider's credentialing process for Superior HealthPlan. Effective for dates of service on or after September 1, 2019, the Medicaid-implemented fee schedule changes for Medicaid services are listed below. 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. You can enter a new search by hitting the New Search image. CMS-1500 forms can be purchased at local office supply stores or by calling the U.S. Government Printing Office at (866) 512-1800. Member Reimbursement Claim Form. Response to your written grievance will not exceed 30-days from receipt of the complaint. If you didnt find any eye care professionals it was probably because you made your search too narrow. Everything needed to begin using the account will be contained in this document, except for your password. How do I find a network provider? 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. Call 1 (877) 201-3602 for a free LASIK consultation. Superior Vision Services Attn: Claims Processing P.O. You may contact us by e-mail at privacy@superiorvision.com. Superior Vision's SmartAlert Wellness Program fosters communication between you, your eye care provider, and your primary care physician or . Experience a faster way to fill out and sign forms on the web. The risk of blindness can be reduced by 90%, with timely treatment and follow-up care. Box 791Latham, NY 12020. 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. Markup is used to associate data and header cells. We collect this data for the purpose of site administration, completing the users current activity, and site customization. Please call our Customer Service department at (800) 507-3800 12-2019. View Top 10 List Why Superior Vision? Superior Vision generally mails reimbursements within 10 business days of receipt to the address you have on file with ERS. Contact lenses Download the necessary form(s), print it out and fill in the required information. We test content for accessibility during production and are constantly working to improve our website accessibility. Firefox Mac: Select button labelled Firefox (orange) at top of screen > Preferences > Content> Color. We welcome any questions regarding Superior Visions privacy & compliance policies and practices.
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