Updated prior authorization forms are now available on the provider portal and the Superior Vision and Davis Vision websites. Updates to the form include but are not limited to primary subscriber ID, individual provider NPI, requested services format, health conditions relevant to visual health, two pairs of single vision glasses in lieu of bifocals benefit, and repair or replacement benefits. All requests should be submitted with complete medical records to ensure timely processing and determination. You will notice fields outlined in red on the updated Routine and Medically Necessary Services and Materials Prior Authorization Request Forms. Those fields are required for processing and should not be blank. The updated forms and FAQs are at the links below from the Superior Vision and Davis Vision websites. If you have questions or concerns, contact information for the Utilization Management Department regarding prior authorization requests is included in the Prior Authorization Request FAQs link below.

• Superior Vision Routine and Medically Necessary Services and Materials Prior Authorization Request Form
• Superior Vision Medical/Surgical Prior Authorization Request Form
• Davis Vision Routine and Medically Necessary Services and Materials Prior Authorization Request Form
• BCBS FEP Routine and Medically Necessary Services and Materials Prior Authorization Request Form
• Prior Authorization Request FAQs