Vision Provider Forms

Commonly Used Forms and Documents

FirstLook Vision Network Office Manual Office Manual for participating eye care professionals (ECPs). Includes ECP responsibilities, covered persons' responsibilities, DOI requirements, schedule of benefits, benefit limitations and exclusions, claim form guidelines and instructions, sample forms, and more.
Provider Network Guide and FAQ Useful information such as ID Card samples, how to submit claims, recognition information and more!
Add/Term Form **NEW** **NEW FORM** Add or remove doctors and/or locations from your practice records. Form fillable PDF document you can fill, print, save and send via email.
Records Change Form **NEW** **NEW FORM** Update your Tax ID, practice name, phone number, address, provider name changes, and more! Form fillable PDF document you can fill, print, save and send via email.
W9 Form Request for Taxpayer Identification Number and Certification, W9 Form. Form fillable PDF document you can fill, print, save and send via email.
Provider Portal Quick Reference for Claims and Authorizations Step-by-step tips to create authorizations for services and file claims, two of the most common activities on AlwaysAssist.
Provider Portal User Guide Detailed User Guide for the AlwaysAssist Provider Portal.
Medically Necessary Contact Lens Request Form Use this form to request medically necessary contact lenses for an AlwaysCare member. Allowable medical conditions are listed on the form. Form fillable PDF document you can fill, print, save and send via email.
Vision Claim Correction Request Use this form to correct or fill in missing information required to process a claim for payment. Instructions provided on the form. Form fillable PDF document you can fill, print, save and send via email.
Vision Claim Modifiers Use this sheet as a reference when filing AlwaysCare Vision claims. Contains CPT Code Modifiers for premium and ultra progressive lenses and specialty contact lens fitting services.
Vision Claim Form for Members Claim Form for Members to submit for reimbursement. Providers should submit claims using online system or HCFA1500/CMS1500.
Safety Eyewear Program Opt In Form To participate in our new Safety Eyewear Program, please follow the directions and return the form to our Provider Relations team to complete your registration.
Opticare of Utah Provider Information As an In-Network provider with AlwaysCare, you have the added benefit of seeing Opticare of Utah members. View the details on this easy-to-read guide.
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