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Carefirst vision claim form

Carefirst vision claim form 2025

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The document is a Vision/Eye Care Claim Form used to submit claims for vision-related services under a health plan. It includes sections for patient and subscriber information, insurance details, authorization for assignment of benefits, and provider information. The form requires completion of various items to ensure proper processing of claims and outlines instructions for both subscribers and providers.

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Click ‘Get Form’ to open the carefirst vision claim form in the editor.
Begin by filling out the Patient and Subscriber Information section. Enter the patient's name, date of birth, and subscriber's name accurately.
Provide details regarding any other insurance coverage under Item 4, and ensure you indicate the subscriber’s ID number in Item 6.
Complete Items 7 through 10, specifying the relationship to the subscriber and providing the subscriber's address. Make sure to check if there are any changes in address.
In Items 11 through 12, certify that all information is correct and authorize payment assignment if applicable. Ensure your signature is included.
For provider information, items 13 through 36 must be completed by your healthcare provider. Ensure they provide all necessary details for processing.
Before submitting, double-check that all sections are filled out completely and keep a copy for your records.

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Versions	Form popularity	Fillable & printable
2018	4.8 Satisfied (65 Votes)
2014	4.3 Satisfied (67 Votes)
2009	4 Satisfied (50 Votes)

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Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

How do you submit a claim to your insurance?

Contact your insurance company Whether you file your car insurance claim over the phone, online, through a mobile app, or with an agent, your insurer will likely request the following details: Location, date, and time of accident. Name, address, phone number, and insurance policy number for all involved in the accident.

How to use vision insurance allowance?

Youll pay separately for the frames and lenses. Your frame allowance is the amount covered by your vision insurance. So, if you have a $150 allowance and pick a frame thats less than $150, youll pay nothing. Choose $200 frames and youll pay $50 at the doctors office (the amount over the allowance).

How to submit a vision insurance claim?

If you visit a non-network provider, submit a claim online by requesting an online claim form link or complete a paper form and mail it to the address listed on the form. Refer to the EyeMed Vision Out of Network Claim form for instructions on requesting an online claim form link.

How do I submit reimbursement to VSP?

When you visit an in-network provider, no claim forms are needed. But, if you go out-of-network, you can submit a claim for reimbursement online from your VSP member account or by contacting VSP Member Services at 800.877.7195 and requesting a claim/reimbursement form.

How to file a Blue Cross Blue Shield vision claim online?

You can submit your out-of-network claim electronically using the mobile app, member log-in portal on our website, or you can obtain claim forms on the website at .bcbsfepvision.com or call 1-888-550-2583 or TTY: 1-800-523-2847.

Does CareFirst BlueChoice cover vision?

Every CareFirst health plan includes basic eye-care benefits for everyone covered by your plan. These important benefits are offered to you through Davis Vision1, the administrator for the products, services and discounts described below.

How do I submit for reimbursement to EyeMed?

You can now submit your form online or by mail. Dont wait to submit your claim - forms must typically be submitted within 15 months of the date of service to receive reimbursement*. To access the out-of-network form or to check the status of a claim, log in to your Member Web account and navigate to the Claims tab.

How long does CareFirst take to process claims?

Almost 80% of claims are received within 30 days from the date of service. In some cases, it can take up to 60 days before your doctor or hospital submits a claim. How quickly we process the claim once its received. More than 90% of claims are processed within seven days of receiving them.

Carefirst vision claim form 2025

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