For out of network providers, the preferred method to submit their claims or vouchers is via mail to:

Davis Vision Claims

PO Box 479

Troy, NY 12181

Superior Vision Claims

PO Box 509

Troy, NY 12181

Claims should be submitted on CMS 1500 forms. Claims should be filled out accurately and completely including all the data elements outlined in the clean claim section of the manual.

For providers requiring support on directions on how to submit a claim electronically and options, please call Customer Service at:

Davis Vision – 1.877.235.5316

Superior Vision – 1.877.235.5317

Yes, as long as the patient’s benefit includes medical optometry through the Versant Health network.

Ancillary services are also called medical optometry services. Some Medicaid plans allow for payment of these services.

You can only enter U&C charges for the following : exams and contact lens fittings claims, doctor-supplied frame and doctor-supplied contact lens orders.

This depends on the plan deadlines; most are 180 days unless listed.

After selecting the member, select doctor supplied frames and spectacle lens on the claim order.