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TABLE OF CONTENTS
New Jersey Specific Information. MARCH Vision Care. Revised December 12, 2019 | Page 2 of 18 . 1.1 Covered Benefits – Aetna Better Health FamilyCare A&B, LTC (Members ages 20 & under & 60 and older) MARCH VISION CARE TEXAS PROVIDER REFERENCE GUIDE MARCH® is committed to working with our contracted providers and their staff to chieve the best possible health outcomes a for our members. This guide provides helpful information about MARCH® eligibility, benefits, claim submission, claim payments, and much more. For easy navigation through this guide, click on the Table of Contents to be taken to the section of OHIO SPECIFIC INFORMATION Deluxe Frame Replacement 10% discount, 1 unit $10 allowance every year. Replacements must be due to normal wear and tear only and is subject to the same minimum lens criteria as initial lenses. OKLAHOMA SPECIFIC INFORMATION Revised April 22, 2021 | Page 4 of 4. 1.2 Covered Benefits – UnitedHealthcare Dual Complete® LP HMO D-SNP (Medicare) H5322-031 . Benefit Benefit Limitations/Criteria MOLINA HEALTHCARE OF FLORIDA, INC. PRACTITIONER APPLICATION Molina Healthcare of Florida, Inc. - Practitioner Application Page 1 of 13 PRACTITIONER NAME: Modification to the wording or format of the Practitioner Application may invalidate the application. MARCH VISION CAREJOIN OUR NETWORKICD-10 INFORMATIONCOMPLIANCE INFORMATIONPROVIDER RESOURCES MARCH specializes in the administration of vision care benefits for managed care organizations, specifically for government sponsored programs such as Medicaid, Medicare, Medicare-Medicaid Plans, and Healthcare Exchange. MARCH also offers a broad range of fully customizable vision care programs to meet the needs of small to mid-sized businesses, self-insured corporations, unions MARCH VISION CARE PROVIDER REFERENCE GUIDE MARCH® is committed to working with our contracted providers and their staff to achieve the best possible health outcomes for our members. This guide provides helpful information about MARCH® eligibility, benefits, claim submission, claim payments, and much more. For easy navigation through this guide, click on the Table of Contents to be taken to the section of ELECTRONIC PAYMENT/REMITTANCE MARCH® Vision Care partners with PaySpan® Health for Electronic Funds Transfers (EFTs) and Electronic Remittance Advices (ERAs). This service is FREE to MARCH® Vision Care providers. PaySpan® Health enables online presentment of remittance/vouchers and straight-forward reconciliation of payments to empower our providers to reduce costs, speed secondary billings, improve cash flow, and MARCH VISION CARE PROVIDER REFERENCE GUIDE Provider Reference Guide | About the Provider Reference Guide MARCH® Vision Care | 3 About the Provider Reference Guide MARCH® is committed to working with our contracted providers and their staff to achieve the best possible health outcomes for our members. This guide provides helpful information about MARCH® eligibility, benefits, claim submission, claim LAB ORDER FORM INSTRUCTIONS Lab Order Form Please fax completed form to (855) 640-6737 MEMBER INFORMATION Member’s Name and Date of Birth: Today’s Date: Member’s ID Number: Date ofTABLE OF CONTENTS
New Jersey Specific Information. MARCH Vision Care. Revised December 12, 2019 | Page 2 of 18 . 1.1 Covered Benefits – Aetna Better Health FamilyCare A&B, LTC (Members ages 20 & under & 60 and older) MARCH VISION CARE TEXAS PROVIDER REFERENCE GUIDE MARCH® is committed to working with our contracted providers and their staff to chieve the best possible health outcomes a for our members. This guide provides helpful information about MARCH® eligibility, benefits, claim submission, claim payments, and much more. For easy navigation through this guide, click on the Table of Contents to be taken to the section of OHIO SPECIFIC INFORMATION Deluxe Frame Replacement 10% discount, 1 unit $10 allowance every year. Replacements must be due to normal wear and tear only and is subject to the same minimum lens criteria as initial lenses. OKLAHOMA SPECIFIC INFORMATION Revised April 22, 2021 | Page 4 of 4. 1.2 Covered Benefits – UnitedHealthcare Dual Complete® LP HMO D-SNP (Medicare) H5322-031 . Benefit Benefit Limitations/Criteria MOLINA HEALTHCARE OF FLORIDA, INC. PRACTITIONER APPLICATION Molina Healthcare of Florida, Inc. - Practitioner Application Page 1 of 13 PRACTITIONER NAME: Modification to the wording or format of the Practitioner Application may invalidate the application.PROVIDER RESOURCES
PROVIDER RESOURCES. For additional information regarding plan administration including coverage criteria, eligibility, claims, claim disputes and/or appeals, and much more, please refer to the Provider Reference Guide below. Provider Reference Guide. Compliance Information. ADDITIONAL RESOURCES: Cultural & Linguistics. ELECTRONIC PAYMENT/REMITTANCE MARCH® Vision Care partners with PaySpan® Health for Electronic Funds Transfers (EFTs) and Electronic Remittance Advices (ERAs). This service is FREE to MARCH® Vision Care providers. PaySpan® Health enables online presentment of remittance/vouchers and straight-forward reconciliation of payments to empower our providers to reduce costs, speed secondary billings, improve cash flow, and FORMS - MARCH VISION CARE disclosure forms are generally required every three (3) years. MARCH® Vision Care only requires Disclosure Forms from these states: NJ and NY. All other states are required to submit forms to the state. Please complete the appropriate disclosure forms for BOTH the individual andgroup, for
DEMOGRAPHICS FORM
Page 4 of 4 Demographics Form 11/19 By entering my name and date below, I attest to MARCH® Vision Care that the information contained in the attached application is trueTABLE OF CONTENTS
New Jersey Specific Information. MARCH Vision Care. Revised December 12, 2019 | Page 2 of 18 . 1.1 Covered Benefits – Aetna Better Health FamilyCare A&B, LTC (Members ages 20 & under & 60 and older) QUICK REFERENCE GUIDE Provider Quick Reference Guide MARCH Vision Care (“MARCH”) administers the primary eye care benefit for UnitedHealthCare and Molina Healthcare’s Centennial Care Program for the Medicaid product. Interactive Voice Recognition System TEXAS SPECIFIC INFORMATION Revised March 5, 2021 | Page 1 of 18 . Texas Specific Information. This document contains information specific to the State of Texas. Please refer to the Provider Reference Guide for general PROVIDER DISPUTE RESOLUTION REQUEST FORM MARCH Vision Care. Provider Dispute Resolution Request Form . Instructions: Please complete the form below. Fields with an asterisk(*) are required.
MOLINA HEALTHCARE OF FLORIDA, INC. PRACTITIONER APPLICATION Molina Healthcare of Florida, Inc. - Practitioner Application Page 1 of 13 PRACTITIONER NAME: Modification to the wording or format of the Practitioner Application may invalidate the application. MISSOURI SPECIFIC INFORMATION Prescription must be at least 0.75 diopters for one eye or .075 diopters for each eye. Prescription for lens/lenses less than 0.75 may be covered if member under MARCH VISION CAREJOIN OUR NETWORKICD-10 INFORMATIONCOMPLIANCE INFORMATIONPROVIDER RESOURCES MARCH specializes in the administration of vision care benefits for managed care organizations, specifically for government sponsored programs such as Medicaid, Medicare, Medicare-Medicaid Plans, and Healthcare Exchange. MARCH also offers a broad range of fully customizable vision care programs to meet the needs of small to mid-sized businesses, self-insured corporations, unions MARCH VISION CARE PROVIDER REFERENCE GUIDE MARCH® is committed to working with our contracted providers and their staff to achieve the best possible health outcomes for our members. This guide provides helpful information about MARCH® eligibility, benefits, claim submission, claim payments, and much more. For easy navigation through this guide, click on the Table of Contents to be taken to the section ofPROVIDER RESOURCES
PROVIDER RESOURCES. For additional information regarding plan administration including coverage criteria, eligibility, claims, claim disputes and/or appeals, and much more, please refer to the Provider Reference Guide below. MARCH VISION CARE PROVIDER REFERENCE GUIDE Provider Reference Guide | About the Provider Reference Guide MARCH® Vision Care | 3 About the Provider Reference Guide MARCH® is committed to working with our contracted providers and their staff to achieve the best possible health outcomes for our members. This guide provides helpful information about MARCH® eligibility, benefits, claim submission, claim LAB ORDER FORM INSTRUCTIONS Lab Order Form Please fax completed form to (855) 640-6737 MEMBER INFORMATION Member’s Name and Date of Birth: Today’s Date: Member’s ID Number: Date of MARCH VISION CARE TEXAS PROVIDER REFERENCE GUIDE MARCH® is committed to working with our contracted providers and their staff to chieve the best possible health outcomes a for our members. This guide provides helpful information about MARCH® eligibility, benefits, claim submission, claim payments, and much more. For easy navigation through this guide, click on the Table of Contents to be taken to the section of MEDICALLY NECESSARY FORM Medically Necessary Contacts Pricing Request Form . Contact Name: Contact Telephone Number: Contact Email Address: Rendering Provider:Tax ID Number:
MOLINA HEALTHCARE OF FLORIDA, INC. PRACTITIONER APPLICATION Molina Healthcare of Florida, Inc. - Practitioner Application Page 1 of 13 PRACTITIONER NAME: Modification to the wording or format of the Practitioner Application may invalidate the application. OHIO SPECIFIC INFORMATION Deluxe Frame Replacement 10% discount, 1 unit $10 allowance every year. Replacements must be due to normal wear and tear only and is subject to the same minimum lens criteria as initial lenses. MISSOURI SPECIFIC INFORMATION Deluxe Frame 10% discount, 1 unit $10 allowance every 2 years ages 21 and older. 10% discount, 1 unit $10 allowance every year ages20 and under or pregnant age 21 and older. MARCH VISION CAREJOIN OUR NETWORKICD-10 INFORMATIONCOMPLIANCE INFORMATIONPROVIDER RESOURCES MARCH specializes in the administration of vision care benefits for managed care organizations, specifically for government sponsored programs such as Medicaid, Medicare, Medicare-Medicaid Plans, and Healthcare Exchange. MARCH also offers a broad range of fully customizable vision care programs to meet the needs of small to mid-sized businesses, self-insured corporations, unions MARCH VISION CARE PROVIDER REFERENCE GUIDE MARCH® is committed to working with our contracted providers and their staff to achieve the best possible health outcomes for our members. This guide provides helpful information about MARCH® eligibility, benefits, claim submission, claim payments, and much more. For easy navigation through this guide, click on the Table of Contents to be taken to the section ofPROVIDER RESOURCES
PROVIDER RESOURCES. For additional information regarding plan administration including coverage criteria, eligibility, claims, claim disputes and/or appeals, and much more, please refer to the Provider Reference Guide below. MARCH VISION CARE PROVIDER REFERENCE GUIDE Provider Reference Guide | About the Provider Reference Guide MARCH® Vision Care | 3 About the Provider Reference Guide MARCH® is committed to working with our contracted providers and their staff to achieve the best possible health outcomes for our members. This guide provides helpful information about MARCH® eligibility, benefits, claim submission, claim LAB ORDER FORM INSTRUCTIONS Lab Order Form Please fax completed form to (855) 640-6737 MEMBER INFORMATION Member’s Name and Date of Birth: Today’s Date: Member’s ID Number: Date of MARCH VISION CARE TEXAS PROVIDER REFERENCE GUIDE MARCH® is committed to working with our contracted providers and their staff to chieve the best possible health outcomes a for our members. This guide provides helpful information about MARCH® eligibility, benefits, claim submission, claim payments, and much more. For easy navigation through this guide, click on the Table of Contents to be taken to the section of MEDICALLY NECESSARY FORM Medically Necessary Contacts Pricing Request Form . Contact Name: Contact Telephone Number: Contact Email Address: Rendering Provider:Tax ID Number:
MOLINA HEALTHCARE OF FLORIDA, INC. PRACTITIONER APPLICATION Molina Healthcare of Florida, Inc. - Practitioner Application Page 1 of 13 PRACTITIONER NAME: Modification to the wording or format of the Practitioner Application may invalidate the application. OHIO SPECIFIC INFORMATION Deluxe Frame Replacement 10% discount, 1 unit $10 allowance every year. Replacements must be due to normal wear and tear only and is subject to the same minimum lens criteria as initial lenses. MISSOURI SPECIFIC INFORMATION Deluxe Frame 10% discount, 1 unit $10 allowance every 2 years ages 21 and older. 10% discount, 1 unit $10 allowance every year ages20 and under or pregnant age 21 and older. DOCTORS AND OFFICE STAFF DOCTORS & OFFICE STAFF. Important Update on COVID-19. MARCH Vision Care’s top priorities are protecting the health of our members and the safety of those who deliver care.CREDENTIALING
If you have any questions about MARCH® Vision Care’s credentialing process, please contact Network Development.Please listen to the prompts that will direct you toFRAME KIT CATALOGS
Please note that not all states require the use of a MARCH® Vision Care frame kit. If your state does not require the use of a frame kit, you will not see your state listed above. ELECTRONIC PAYMENT/REMITTANCE MARCH® Vision Care partners with PaySpan® Health for Electronic Funds Transfers (EFTs) and Electronic Remittance Advices (ERAs). This service is FREE to MARCH® Vision Care providers. PaySpan® Health enables online presentment of remittance/vouchers and straight-forward reconciliation of payments to empower our providers to reduce costs, speed secondary billings, improve cash flow, and FORMS - MARCH VISION CARE In order to comply with Federal Regulations, effective December 1, 2014, MARCH® Vision Care will suspend payment to providers who have failed to comply and have not submitted a LAB ORDER FORM INSTRUCTIONS Lab Order Form Please fax completed form to (855) 640-6737 MEMBER INFORMATION Member’s Name and Date of Birth: Today’s Date: Member’s ID Number: Date ofTABLE OF CONTENTS
New Jersey Specific Information. MARCH Vision Care. Revised December 12, 2019 | Page 2 of 18 . 1.1 Covered Benefits – Aetna Better Health FamilyCare A&B, LTC (Members ages 20 & under & 60 and older)DEMOGRAPHICS FORM
Page 4 of 4 Demographics Form 11/19 By entering my name and date below, I attest to MARCH® Vision Care that the information contained in the attached application is true MARCH VISION CARE TEXAS PROVIDER REFERENCE GUIDE MARCH® is committed to working with our contracted providers and their staff to chieve the best possible health outcomes a for our members. This guide provides helpful information about MARCH® eligibility, benefits, claim submission, claim payments, and much more. For easy navigation through this guide, click on the Table of Contents to be taken to the section of KENTUCKY PROVIDER REFERENCE GUIDE MARCH® is committed to working with our contracted providers and the staff irto achieve the best possible health outcomes for our members. This guide provides helpful information about MARCH® eligibility, benefits, claim submission, claim payments, and much more. For easy navigation through this guide, click on the Table of Contents to be taken to the section of MARCH VISION CAREJOIN OUR NETWORKICD-10 INFORMATIONCOMPLIANCE INFORMATIONPROVIDER RESOURCES MARCH specializes in the administration of vision care benefits for managed care organizations, specifically for government sponsored programs such as Medicaid, Medicare, Medicare-Medicaid Plans, and Healthcare Exchange. MARCH also offers a broad range of fully customizable vision care programs to meet the needs of small to mid-sized businesses, self-insured corporations, unions MARCH VISION CARE PROVIDER REFERENCE GUIDE MARCH® is committed to working with our contracted providers and their staff to achieve the best possible health outcomes for our members. This guide provides helpful information about MARCH® eligibility, benefits, claim submission, claim payments, and much more. For easy navigation through this guide, click on the Table of Contents to be taken to the section of MARCH VISION CARE PROVIDER REFERENCE GUIDE Provider Reference Guide | About the Provider Reference Guide MARCH® Vision Care | 3 About the Provider Reference Guide MARCH® is committed to working with our contracted providers and their staff to achieve the best possible health outcomes for our members. This guide provides helpful information about MARCH® eligibility, benefits, claim submission, claim ELECTRONIC PAYMENT/REMITTANCE MARCH® Vision Care partners with PaySpan® Health for Electronic Funds Transfers (EFTs) and Electronic Remittance Advices (ERAs). This service is FREE to MARCH® Vision Care providers. PaySpan® Health enables online presentment of remittance/vouchers and straight-forward reconciliation of payments to empower our providers to reduce costs, speed secondary billings, improve cash flow, and HELP PAGE - MARCH VISION CARE Help. Welcome to the March Vision Care Website! If you are experiencing technical difficulties or just have a suggestion, please send an e-mail to marchsupport@marchvisioncare.com. Technical support is available Monday through Friday, 8:00 a.m. to 5:00 p.m. PST by contacting MARCH® Vision Cares's Customer Service Department. LAB ORDER FORM INSTRUCTIONS Lab Order Form Please fax completed form to (855) 640-6737 MEMBER INFORMATION Member’s Name and Date of Birth: Today’s Date: Member’s ID Number: Date of MEDICALLY NECESSARY FORM Medically Necessary Contacts Pricing Request Form . Contact Name: Contact Telephone Number: Contact Email Address: Rendering Provider:Tax ID Number:
DEMOGRAPHICS FORM
Page 4 of 4 Demographics Form 11/19 By entering my name and date below, I attest to MARCH® Vision Care that the information contained in the attached application is true OKLAHOMA SPECIFIC INFORMATION Revised April 22, 2021 | Page 4 of 4. 1.2 Covered Benefits – UnitedHealthcare Dual Complete® LP HMO D-SNP (Medicare) H5322-031 . Benefit Benefit Limitations/Criteria PROVIDER APPEAL REQUEST FORM Provider Appeal Request Form Instructions: Please complete the form below. Fields with an asterisk (*) are required. Be specific when completing DESCRIPTION OF APPEAL and EXPECTED OUTCOME. MARCH VISION CAREJOIN OUR NETWORKICD-10 INFORMATIONCOMPLIANCE INFORMATIONPROVIDER RESOURCES MARCH specializes in the administration of vision care benefits for managed care organizations, specifically for government sponsored programs such as Medicaid, Medicare, Medicare-Medicaid Plans, and Healthcare Exchange. MARCH also offers a broad range of fully customizable vision care programs to meet the needs of small to mid-sized businesses, self-insured corporations, unions MARCH VISION CARE PROVIDER REFERENCE GUIDE MARCH® is committed to working with our contracted providers and their staff to achieve the best possible health outcomes for our members. This guide provides helpful information about MARCH® eligibility, benefits, claim submission, claim payments, and much more. For easy navigation through this guide, click on the Table of Contents to be taken to the section of MARCH VISION CARE PROVIDER REFERENCE GUIDE Provider Reference Guide | About the Provider Reference Guide MARCH® Vision Care | 3 About the Provider Reference Guide MARCH® is committed to working with our contracted providers and their staff to achieve the best possible health outcomes for our members. This guide provides helpful information about MARCH® eligibility, benefits, claim submission, claim ELECTRONIC PAYMENT/REMITTANCE MARCH® Vision Care partners with PaySpan® Health for Electronic Funds Transfers (EFTs) and Electronic Remittance Advices (ERAs). This service is FREE to MARCH® Vision Care providers. PaySpan® Health enables online presentment of remittance/vouchers and straight-forward reconciliation of payments to empower our providers to reduce costs, speed secondary billings, improve cash flow, and HELP PAGE - MARCH VISION CARE Help. Welcome to the March Vision Care Website! If you are experiencing technical difficulties or just have a suggestion, please send an e-mail to marchsupport@marchvisioncare.com. Technical support is available Monday through Friday, 8:00 a.m. to 5:00 p.m. PST by contacting MARCH® Vision Cares's Customer Service Department. LAB ORDER FORM INSTRUCTIONS Lab Order Form Please fax completed form to (855) 640-6737 MEMBER INFORMATION Member’s Name and Date of Birth: Today’s Date: Member’s ID Number: Date of MEDICALLY NECESSARY FORM Medically Necessary Contacts Pricing Request Form . Contact Name: Contact Telephone Number: Contact Email Address: Rendering Provider:Tax ID Number:
DEMOGRAPHICS FORM
Page 4 of 4 Demographics Form 11/19 By entering my name and date below, I attest to MARCH® Vision Care that the information contained in the attached application is true OKLAHOMA SPECIFIC INFORMATION Revised April 22, 2021 | Page 4 of 4. 1.2 Covered Benefits – UnitedHealthcare Dual Complete® LP HMO D-SNP (Medicare) H5322-031 . Benefit Benefit Limitations/Criteria PROVIDER APPEAL REQUEST FORM Provider Appeal Request Form Instructions: Please complete the form below. Fields with an asterisk (*) are required. Be specific when completing DESCRIPTION OF APPEAL and EXPECTED OUTCOME. MARCH VISION CARE PROVIDER REFERENCE GUIDE Provider Reference Guide | About the Provider Reference Guide MARCH® Vision Care | 3 About the Provider Reference Guide MARCH® is committed to working with our contracted providers and their staff to achieve the best possible health outcomes for our members. This guide provides helpful information about MARCH® eligibility, benefits, claim submission, claimPROVIDER RESOURCES
PROVIDER RESOURCES. For additional information regarding plan administration including coverage criteria, eligibility, claims, claim disputes and/or appeals, and much more, please refer to the Provider Reference Guide below. Provider Reference Guide. Compliance Information. ADDITIONAL RESOURCES: Cultural & Linguistics.FRAME KIT CATALOGS
FRAME KIT CATALOGS. For a copy of your MARCH® Vision Care frame kit catalog, please select your state: Please note that not all states require the use of a MARCH® Vision Care frame kit. If your state does not require the use of a frame kit, you will not see your state listed above. If you have any questions, please contact our Provider HELP PAGE - MARCH VISION CARE Help. Welcome to the March Vision Care Website! If you are experiencing technical difficulties or just have a suggestion, please send an e-mail to marchsupport@marchvisioncare.com. Technical support is available Monday through Friday, 8:00 a.m. to 5:00 p.m. PST by contacting MARCH® Vision Cares's Customer Service Department. FORMS - MARCH VISION CARE DISCLOSURE OF OWNERSHIP AND CONTROL INTEREST STATEMENT. Please answer all questions on the form as of the current date. If additional space is needed, please note on the form that the answer is being continuedon a separate
DEMOGRAPHICS FORM
Page 4 of 4 Demographics Form 11/19 By entering my name and date below, I attest to MARCH® Vision Care that the information contained in the attached application is true QUICK REFERENCE GUIDE Provider Quick Reference Guide MARCH Vision Care (“MARCH”) administers the primary eye care benefit for UnitedHealthCare and Molina Healthcare’s Centennial Care Program for the Medicaid product. Interactive Voice Recognition System PROVIDER APPEAL REQUEST FORM Provider Appeal Request Form Instructions: Please complete the form below. Fields with an asterisk (*) are required. Be specific when completing DESCRIPTION OF APPEAL and EXPECTED OUTCOME. MOLINA HEALTHCARE OF FLORIDA, INC. PRACTITIONER APPLICATION Molina Healthcare of Florida, Inc. - Practitioner Application Page 1 of 13 PRACTITIONER NAME: Modification to the wording or format of the Practitioner Application may invalidate the application. 2019 ANNUAL COMPLIANCE AND FRAUD WASTE AND ABUSE TRAINING Page 2 of 2 workers and volunteers), the CEO, senior administrators or managers, governing body members, and sub-delegates who are involved in the administration or delivery MARCH VISION CAREJOIN OUR NETWORKICD-10 INFORMATIONCOMPLIANCE INFORMATIONPROVIDER RESOURCES MARCH specializes in the administration of vision care benefits for managed care organizations, specifically for government sponsored programs such as Medicaid, Medicare, Medicare-Medicaid Plans, and Healthcare Exchange. MARCH also offers a broad range of fully customizable vision care programs to meet the needs of small to mid-sized businesses, self-insured corporations, unions MARCH VISION CARE PROVIDER REFERENCE GUIDE MARCH® is committed to working with our contracted providers and their staff to achieve the best possible health outcomes for our members. This guide provides helpful information about MARCH® eligibility, benefits, claim submission, claim payments, and much more. For easy navigation through this guide, click on the Table of Contents to be taken to the section of MARCH VISION CARE PROVIDER REFERENCE GUIDE Provider Reference Guide | About the Provider Reference Guide MARCH® Vision Care | 3 About the Provider Reference Guide MARCH® is committed to working with our contracted providers and their staff to achieve the best possible health outcomes for our members. This guide provides helpful information about MARCH® eligibility, benefits, claim submission, claim ELECTRONIC PAYMENT/REMITTANCE MARCH® Vision Care partners with PaySpan® Health for Electronic Funds Transfers (EFTs) and Electronic Remittance Advices (ERAs). This service is FREE to MARCH® Vision Care providers. PaySpan® Health enables online presentment of remittance/vouchers and straight-forward reconciliation of payments to empower our providers to reduce costs, speed secondary billings, improve cash flow, and HELP PAGE - MARCH VISION CARE Help. Welcome to the March Vision Care Website! If you are experiencing technical difficulties or just have a suggestion, please send an e-mail to marchsupport@marchvisioncare.com. Technical support is available Monday through Friday, 8:00 a.m. to 5:00 p.m. PST by contacting MARCH® Vision Cares's Customer Service Department. LAB ORDER FORM INSTRUCTIONS Lab Order Form Please fax completed form to (855) 640-6737 MEMBER INFORMATION Member’s Name and Date of Birth: Today’s Date: Member’s ID Number: Date of MEDICALLY NECESSARY FORM Medically Necessary Contacts Pricing Request Form . Contact Name: Contact Telephone Number: Contact Email Address: Rendering Provider:Tax ID Number:
DEMOGRAPHICS FORM
Page 4 of 4 Demographics Form 11/19 By entering my name and date below, I attest to MARCH® Vision Care that the information contained in the attached application is true OKLAHOMA SPECIFIC INFORMATION Revised April 22, 2021 | Page 4 of 4. 1.2 Covered Benefits – UnitedHealthcare Dual Complete® LP HMO D-SNP (Medicare) H5322-031 . Benefit Benefit Limitations/Criteria PROVIDER APPEAL REQUEST FORM Provider Appeal Request Form Instructions: Please complete the form below. Fields with an asterisk (*) are required. Be specific when completing DESCRIPTION OF APPEAL and EXPECTED OUTCOME. MARCH VISION CAREJOIN OUR NETWORKICD-10 INFORMATIONCOMPLIANCE INFORMATIONPROVIDER RESOURCES MARCH specializes in the administration of vision care benefits for managed care organizations, specifically for government sponsored programs such as Medicaid, Medicare, Medicare-Medicaid Plans, and Healthcare Exchange. MARCH also offers a broad range of fully customizable vision care programs to meet the needs of small to mid-sized businesses, self-insured corporations, unions MARCH VISION CARE PROVIDER REFERENCE GUIDE MARCH® is committed to working with our contracted providers and their staff to achieve the best possible health outcomes for our members. This guide provides helpful information about MARCH® eligibility, benefits, claim submission, claim payments, and much more. For easy navigation through this guide, click on the Table of Contents to be taken to the section of MARCH VISION CARE PROVIDER REFERENCE GUIDE Provider Reference Guide | About the Provider Reference Guide MARCH® Vision Care | 3 About the Provider Reference Guide MARCH® is committed to working with our contracted providers and their staff to achieve the best possible health outcomes for our members. This guide provides helpful information about MARCH® eligibility, benefits, claim submission, claim ELECTRONIC PAYMENT/REMITTANCE MARCH® Vision Care partners with PaySpan® Health for Electronic Funds Transfers (EFTs) and Electronic Remittance Advices (ERAs). This service is FREE to MARCH® Vision Care providers. PaySpan® Health enables online presentment of remittance/vouchers and straight-forward reconciliation of payments to empower our providers to reduce costs, speed secondary billings, improve cash flow, and HELP PAGE - MARCH VISION CARE Help. Welcome to the March Vision Care Website! If you are experiencing technical difficulties or just have a suggestion, please send an e-mail to marchsupport@marchvisioncare.com. Technical support is available Monday through Friday, 8:00 a.m. to 5:00 p.m. PST by contacting MARCH® Vision Cares's Customer Service Department. LAB ORDER FORM INSTRUCTIONS Lab Order Form Please fax completed form to (855) 640-6737 MEMBER INFORMATION Member’s Name and Date of Birth: Today’s Date: Member’s ID Number: Date of MEDICALLY NECESSARY FORM Medically Necessary Contacts Pricing Request Form . Contact Name: Contact Telephone Number: Contact Email Address: Rendering Provider:Tax ID Number:
DEMOGRAPHICS FORM
Page 4 of 4 Demographics Form 11/19 By entering my name and date below, I attest to MARCH® Vision Care that the information contained in the attached application is true OKLAHOMA SPECIFIC INFORMATION Revised April 22, 2021 | Page 4 of 4. 1.2 Covered Benefits – UnitedHealthcare Dual Complete® LP HMO D-SNP (Medicare) H5322-031 . Benefit Benefit Limitations/Criteria PROVIDER APPEAL REQUEST FORM Provider Appeal Request Form Instructions: Please complete the form below. Fields with an asterisk (*) are required. Be specific when completing DESCRIPTION OF APPEAL and EXPECTED OUTCOME. MARCH VISION CARE PROVIDER REFERENCE GUIDE Provider Reference Guide | About the Provider Reference Guide MARCH® Vision Care | 3 About the Provider Reference Guide MARCH® is committed to working with our contracted providers and their staff to achieve the best possible health outcomes for our members. This guide provides helpful information about MARCH® eligibility, benefits, claim submission, claimPROVIDER RESOURCES
PROVIDER RESOURCES. For additional information regarding plan administration including coverage criteria, eligibility, claims, claim disputes and/or appeals, and much more, please refer to the Provider Reference Guide below. Provider Reference Guide. Compliance Information. ADDITIONAL RESOURCES: Cultural & Linguistics.FRAME KIT CATALOGS
FRAME KIT CATALOGS. For a copy of your MARCH® Vision Care frame kit catalog, please select your state: Please note that not all states require the use of a MARCH® Vision Care frame kit. If your state does not require the use of a frame kit, you will not see your state listed above. If you have any questions, please contact our Provider HELP PAGE - MARCH VISION CARE Help. Welcome to the March Vision Care Website! If you are experiencing technical difficulties or just have a suggestion, please send an e-mail to marchsupport@marchvisioncare.com. Technical support is available Monday through Friday, 8:00 a.m. to 5:00 p.m. PST by contacting MARCH® Vision Cares's Customer Service Department. FORMS - MARCH VISION CARE DISCLOSURE OF OWNERSHIP AND CONTROL INTEREST STATEMENT. Please answer all questions on the form as of the current date. If additional space is needed, please note on the form that the answer is being continuedon a separate
DEMOGRAPHICS FORM
Page 4 of 4 Demographics Form 11/19 By entering my name and date below, I attest to MARCH® Vision Care that the information contained in the attached application is true QUICK REFERENCE GUIDE Provider Quick Reference Guide MARCH Vision Care (“MARCH”) administers the primary eye care benefit for UnitedHealthCare and Molina Healthcare’s Centennial Care Program for the Medicaid product. Interactive Voice Recognition System PROVIDER APPEAL REQUEST FORM Provider Appeal Request Form Instructions: Please complete the form below. Fields with an asterisk (*) are required. Be specific when completing DESCRIPTION OF APPEAL and EXPECTED OUTCOME. MOLINA HEALTHCARE OF FLORIDA, INC. PRACTITIONER APPLICATION Molina Healthcare of Florida, Inc. - Practitioner Application Page 1 of 13 PRACTITIONER NAME: Modification to the wording or format of the Practitioner Application may invalidate the application. 2019 ANNUAL COMPLIANCE AND FRAUD WASTE AND ABUSE TRAINING Page 2 of 2 workers and volunteers), the CEO, senior administrators or managers, governing body members, and sub-delegates who are involved in the administration or delivery MARCH VISION CAREJOIN OUR NETWORKICD-10 INFORMATIONCOMPLIANCE INFORMATIONPROVIDER RESOURCES MARCH specializes in the administration of vision care benefits for managed care organizations, specifically for government sponsored programs such as Medicaid, Medicare, Medicare-Medicaid Plans, and Healthcare Exchange. MARCH also offers a broad range of fully customizable vision care programs to meet the needs of small to mid-sized businesses, self-insured corporations, unions MARCH VISION CARE PROVIDER REFERENCE GUIDE Provider Reference Guide | About the Provider Reference Guide MARCH® Vision Care | 3 About the Provider Reference Guide MARCH® is committed to working with our contracted providers and their staff to achieve the best possible health outcomes for our members. This guide provides helpful information about MARCH® eligibility, benefits, claim submission, claim MARCH VISION CARE PROVIDER REFERENCE GUIDE MARCH® is committed to working with our contracted providers and their staff to achieve the best possible health outcomes for our members. This guide provides helpful information about MARCH® eligibility, benefits, claim submission, claim payments, and much more. For easy navigation through this guide, click on the Table of Contents to be taken to the section of QUICK REFERENCE GUIDE Provider Quick Reference Guide MARCH Vision Care (“MARCH”) administers the primary eye care benefit for UnitedHealthCare and Molina Healthcare’s Centennial Care Program for the Medicaid product. Interactive Voice Recognition System LAB ORDER FORM INSTRUCTIONS Lab Order Form Please fax completed form to (855) 640-6737 MEMBER INFORMATION Member’s Name and Date of Birth: Today’s Date: Member’s ID Number: Date ofTABLE OF CONTENTS
Exam 1 service date every year. Includes dilation, if professionally indicated. Necessary Medical Services Covered as needed when services are performed by an optometrist and are within the scope of licensure. MEDICALLY NECESSARY FORM Medically Necessary Contacts Pricing Request Form . Contact Name: Contact Telephone Number: Contact Email Address: Rendering Provider:Tax ID Number:
OKLAHOMA SPECIFIC INFORMATION Revised April 22, 2021 | Page 4 of 4. 1.2 Covered Benefits – UnitedHealthcare Dual Complete® LP HMO D-SNP (Medicare) H5322-031 . Benefit Benefit Limitations/Criteria OHIO SPECIFIC INFORMATION Deluxe Frame Replacement 10% discount, 1 unit $10 allowance every year. Replacements must be due to normal wear and tear only and is subject to the same minimum lens criteria as initial lenses. MOLINA HEALTHCARE OF FLORIDA, INC. PRACTITIONER APPLICATION Molina Healthcare of Florida, Inc. - Practitioner Application Page 1 of 13 PRACTITIONER NAME: Modification to the wording or format of the Practitioner Application may invalidate the application. MARCH VISION CAREJOIN OUR NETWORKICD-10 INFORMATIONCOMPLIANCE INFORMATIONPROVIDER RESOURCES MARCH specializes in the administration of vision care benefits for managed care organizations, specifically for government sponsored programs such as Medicaid, Medicare, Medicare-Medicaid Plans, and Healthcare Exchange. MARCH also offers a broad range of fully customizable vision care programs to meet the needs of small to mid-sized businesses, self-insured corporations, unions MARCH VISION CARE PROVIDER REFERENCE GUIDE Provider Reference Guide | About the Provider Reference Guide MARCH® Vision Care | 3 About the Provider Reference Guide MARCH® is committed to working with our contracted providers and their staff to achieve the best possible health outcomes for our members. This guide provides helpful information about MARCH® eligibility, benefits, claim submission, claim MARCH VISION CARE PROVIDER REFERENCE GUIDE MARCH® is committed to working with our contracted providers and their staff to achieve the best possible health outcomes for our members. This guide provides helpful information about MARCH® eligibility, benefits, claim submission, claim payments, and much more. For easy navigation through this guide, click on the Table of Contents to be taken to the section of QUICK REFERENCE GUIDE Provider Quick Reference Guide MARCH Vision Care (“MARCH”) administers the primary eye care benefit for UnitedHealthCare and Molina Healthcare’s Centennial Care Program for the Medicaid product. Interactive Voice Recognition System LAB ORDER FORM INSTRUCTIONS Lab Order Form Please fax completed form to (855) 640-6737 MEMBER INFORMATION Member’s Name and Date of Birth: Today’s Date: Member’s ID Number: Date ofTABLE OF CONTENTS
Exam 1 service date every year. Includes dilation, if professionally indicated. Necessary Medical Services Covered as needed when services are performed by an optometrist and are within the scope of licensure. MEDICALLY NECESSARY FORM Medically Necessary Contacts Pricing Request Form . Contact Name: Contact Telephone Number: Contact Email Address: Rendering Provider:Tax ID Number:
OKLAHOMA SPECIFIC INFORMATION Revised April 22, 2021 | Page 4 of 4. 1.2 Covered Benefits – UnitedHealthcare Dual Complete® LP HMO D-SNP (Medicare) H5322-031 . Benefit Benefit Limitations/Criteria OHIO SPECIFIC INFORMATION Deluxe Frame Replacement 10% discount, 1 unit $10 allowance every year. Replacements must be due to normal wear and tear only and is subject to the same minimum lens criteria as initial lenses. MOLINA HEALTHCARE OF FLORIDA, INC. PRACTITIONER APPLICATION Molina Healthcare of Florida, Inc. - Practitioner Application Page 1 of 13 PRACTITIONER NAME: Modification to the wording or format of the Practitioner Application may invalidate the application. ELECTRONIC PAYMENT/REMITTANCE MARCH® Vision Care partners with PaySpan® Health for Electronic Funds Transfers (EFTs) and Electronic Remittance Advices (ERAs). This service is FREE to MARCH® Vision Care providers. PaySpan® Health enables online presentment of remittance/vouchers and straight-forward reconciliation of payments to empower our providers to reduce costs, speed secondary billings, improve cash flow, and HELP PAGE - MARCH VISION CARE Help. Welcome to the March Vision Care Website! If you are experiencing technical difficulties or just have a suggestion, please send an e-mail to marchsupport@marchvisioncare.com. Technical support is available Monday through Friday, 8:00 a.m. to 5:00 p.m. PST by contacting MARCH® Vision Cares's Customer Service Department. QUICK REFERENCE GUIDE Provider Quick Reference Guide MARCH Vision Care (“MARCH”) administers the primary eye care benefit for UnitedHealthCare and Molina Healthcare’s Centennial Care Program for the Medicaid product. Interactive Voice Recognition SystemTABLE OF CONTENTS
New Jersey Specific Information. MARCH Vision Care. Revised December 12, 2019 | Page 2 of 18 . 1.1 Covered Benefits – Aetna Better Health FamilyCare A&B, LTC (Members ages 20 & under & 60 and older)TABLE OF CONTENTS
Exam 1 service date every year. Includes dilation, if professionally indicated. Necessary Medical Services Covered as needed when services are performed by an optometrist and are within the scope of licensure.TABLE OF CONTENTS
Necessary Medical Services Covered as needed when services are performed by an optometrist and are within the scope of licensure. Frame 1 unit every 2 yearswhen frame is within the provider’s designated Medi-Cal selection.MARCH VISION CARE
Mississippi Provider Reference Guide | About the Provider Reference Guide MARCH® Vision Care | 3 About the Provider Reference Guide MARCH® is committed to working with our contracted providers and their staff to achieve the best possible health outcomes for our members. This guide provides helpful information about MARCH® eligibility, benefits, claim submission, claim PCA-1-21-00002-MARCOMM-FAQ VISION DUAL BRAND FAQ 01212021 Title: Microsoft Word - PCA-1-21-00002-MarComm-FAQ_Vision Dual Brand FAQ_01212021 Author: bisrael Created Date: 1/22/2021 11:40:10 AM MISSOURI SPECIFIC INFORMATION Prescription must be at least 0.75 diopters for one eye or .075 diopters for each eye. Prescription for lens/lenses less than 0.75 may be covered if member under 2019 ANNUAL COMPLIANCE AND FRAUD WASTE AND ABUSE TRAINING Page 2 of 2 workers and volunteers), the CEO, senior administrators or managers, governing body members, and sub-delegates who are involved in the administration or delivery MARCH VISION CAREJOIN OUR NETWORKICD-10 INFORMATIONCOMPLIANCE INFORMATIONPROVIDER RESOURCES MARCH specializes in the administration of vision care benefits for managed care organizations, specifically for government sponsored programs such as Medicaid, Medicare, Medicare-Medicaid Plans, and Healthcare Exchange. MARCH also offers a broad range of fully customizable vision care programs to meet the needs of small to mid-sized businesses, self-insured corporations, unionsPROVIDER RESOURCES
PROVIDER RESOURCES. For additional information regarding plan administration including coverage criteria, eligibility, claims, claim disputes and/or appeals, and much more, please refer to the Provider Reference Guide below. Provider Reference Guide. Compliance Information. ADDITIONAL RESOURCES: Cultural & Linguistics. MARCH VISION CARE PROVIDER REFERENCE GUIDE MARCH® is committed to working with our contracted providers and their staff to achieve the best possible health outcomes for our members. This guide provides helpful information about MARCH® eligibility, benefits, claim submission, claim payments, and much more. For easy navigation through this guide, click on the Table of Contents to be taken to the section of MARCH VISION CARE PROVIDER REFERENCE GUIDE Provider Reference Guide | About the Provider Reference Guide MARCH® Vision Care | 3 About the Provider Reference Guide MARCH® is committed to working with our contracted providers and their staff to achieve the best possible health outcomes for our members. This guide provides helpful information about MARCH® eligibility, benefits, claim submission, claim LAB ORDER FORM INSTRUCTIONS Lab Order Form Please fax completed form to (855) 640-6737 MEMBER INFORMATION Member’s Name and Date of Birth: Today’s Date: Member’s ID Number: Date ofTABLE OF CONTENTS
Exam 1 service date every year. Includes dilation, if professionally indicated. Necessary Medical Services Covered as needed when services are performed by an optometrist and are within the scope of licensure. TEXAS SPECIFIC INFORMATION Revised March 5, 2021 | Page 1 of 18 . Texas Specific Information. This document contains information specific to the State of Texas. Please refer to the Provider Reference Guide for general OHIO SPECIFIC INFORMATION Deluxe Frame Replacement 10% discount, 1 unit $10 allowance every year. Replacements must be due to normal wear and tear only and is subject to the same minimum lens criteria as initial lenses. OKLAHOMA SPECIFIC INFORMATION Revised April 22, 2021 | Page 4 of 4. 1.2 Covered Benefits – UnitedHealthcare Dual Complete® LP HMO D-SNP (Medicare) H5322-031 . Benefit Benefit Limitations/Criteria MOLINA HEALTHCARE OF FLORIDA, INC. PRACTITIONER APPLICATION Molina Healthcare of Florida, Inc. - Practitioner Application Page 1 of 13 PRACTITIONER NAME: Modification to the wording or format of the Practitioner Application may invalidate the application. MARCH VISION CAREJOIN OUR NETWORKICD-10 INFORMATIONCOMPLIANCE INFORMATIONPROVIDER RESOURCES MARCH specializes in the administration of vision care benefits for managed care organizations, specifically for government sponsored programs such as Medicaid, Medicare, Medicare-Medicaid Plans, and Healthcare Exchange. MARCH also offers a broad range of fully customizable vision care programs to meet the needs of small to mid-sized businesses, self-insured corporations, unionsPROVIDER RESOURCES
PROVIDER RESOURCES. For additional information regarding plan administration including coverage criteria, eligibility, claims, claim disputes and/or appeals, and much more, please refer to the Provider Reference Guide below. Provider Reference Guide. Compliance Information. ADDITIONAL RESOURCES: Cultural & Linguistics. MARCH VISION CARE PROVIDER REFERENCE GUIDE MARCH® is committed to working with our contracted providers and their staff to achieve the best possible health outcomes for our members. This guide provides helpful information about MARCH® eligibility, benefits, claim submission, claim payments, and much more. For easy navigation through this guide, click on the Table of Contents to be taken to the section of MARCH VISION CARE PROVIDER REFERENCE GUIDE Provider Reference Guide | About the Provider Reference Guide MARCH® Vision Care | 3 About the Provider Reference Guide MARCH® is committed to working with our contracted providers and their staff to achieve the best possible health outcomes for our members. This guide provides helpful information about MARCH® eligibility, benefits, claim submission, claim LAB ORDER FORM INSTRUCTIONS Lab Order Form Please fax completed form to (855) 640-6737 MEMBER INFORMATION Member’s Name and Date of Birth: Today’s Date: Member’s ID Number: Date ofTABLE OF CONTENTS
Exam 1 service date every year. Includes dilation, if professionally indicated. Necessary Medical Services Covered as needed when services are performed by an optometrist and are within the scope of licensure. TEXAS SPECIFIC INFORMATION Revised March 5, 2021 | Page 1 of 18 . Texas Specific Information. This document contains information specific to the State of Texas. Please refer to the Provider Reference Guide for general OHIO SPECIFIC INFORMATION Deluxe Frame Replacement 10% discount, 1 unit $10 allowance every year. Replacements must be due to normal wear and tear only and is subject to the same minimum lens criteria as initial lenses. OKLAHOMA SPECIFIC INFORMATION Revised April 22, 2021 | Page 4 of 4. 1.2 Covered Benefits – UnitedHealthcare Dual Complete® LP HMO D-SNP (Medicare) H5322-031 . Benefit Benefit Limitations/Criteria MOLINA HEALTHCARE OF FLORIDA, INC. PRACTITIONER APPLICATION Molina Healthcare of Florida, Inc. - Practitioner Application Page 1 of 13 PRACTITIONER NAME: Modification to the wording or format of the Practitioner Application may invalidate the application. HELP PAGE - MARCH VISION CARE Help. Welcome to the March Vision Care Website! If you are experiencing technical difficulties or just have a suggestion, please send an e-mail to marchsupport@marchvisioncare.com. Technical support is available Monday through Friday, 8:00 a.m. to 5:00 p.m. PST by contacting MARCH® Vision Cares's Customer Service Department. ELECTRONIC PAYMENT/REMITTANCE MARCH® Vision Care partners with PaySpan® Health for Electronic Funds Transfers (EFTs) and Electronic Remittance Advices (ERAs). This service is FREE to MARCH® Vision Care providers. PaySpan® Health enables online presentment of remittance/vouchers and straight-forward reconciliation of payments to empower our providers to reduce costs, speed secondary billings, improve cash flow, and QUICK REFERENCE GUIDE Provider Quick Reference Guide MARCH Vision Care (“MARCH”) administers the primary eye care benefit for UnitedHealthCare and Molina Healthcare’s Centennial Care Program for the Medicaid product. Interactive Voice Recognition SystemTABLE OF CONTENTS
Necessary Medical Services Covered as needed when services are performed by an optometrist and are within the scope of licensure. Frame 1 unit every 2 yearswhen frame is within the provider’s designated Medi-Cal selection.MARCH VISION CARE
Mississippi Provider Reference Guide | About the Provider Reference Guide MARCH® Vision Care | 3 About the Provider Reference Guide MARCH® is committed to working with our contracted providers and their staff to achieve the best possible health outcomes for our members. This guide provides helpful information about MARCH® eligibility, benefits, claim submission, claim MEDICALLY NECESSARY FORM Medically Necessary Contacts Pricing Request Form . Contact Name: Contact Telephone Number: Contact Email Address: Rendering Provider:Tax ID Number:
DEMOGRAPHICS FORM
Page 4 of 4 Demographics Form 11/19 By entering my name and date below, I attest to MARCH® Vision Care that the information contained in the attached application is trueTABLE OF CONTENTS
New York Specific Information MARCH Vision Care Revised December 16, 2019 | Page 1 of 13 . This document contains information specific to the State of New York. Please refer to MISSOURI SPECIFIC INFORMATION Prescription must be at least 0.75 diopters for one eye or .075 diopters for each eye. Prescription for lens/lenses less than 0.75 may be covered if member under W-9 REQUEST FOR TAXPAYER IDENTIFICATION NUMBER AND Form W-9 (Rev. 12-2014) Page 2 Note. If you are a U.S. person and a requester gives you a form other than Form W-9 to request your TIN, you must use the requester’s form if it is substantially MARCH VISION CAREJOIN OUR NETWORKICD-10 INFORMATIONCOMPLIANCE INFORMATIONPROVIDER RESOURCES MARCH specializes in the administration of vision care benefits for managed care organizations, specifically for government sponsored programs such as Medicaid, Medicare, Medicare-Medicaid Plans, and Healthcare Exchange. MARCH also offers a broad range of fully customizable vision care programs to meet the needs of small to mid-sized businesses, self-insured corporations, unionsPROVIDER RESOURCES
PROVIDER RESOURCES. For additional information regarding plan administration including coverage criteria, eligibility, claims, claim disputes and/or appeals, and much more, please refer to the Provider Reference Guide below. Provider Reference Guide. Compliance Information. ADDITIONAL RESOURCES: Cultural & Linguistics. MARCH VISION CARE PROVIDER REFERENCE GUIDE Provider Reference Guide | About the Provider Reference Guide MARCH® Vision Care | 3 About the Provider Reference Guide MARCH® is committed to working with our contracted providers and their staff to achieve the best possible health outcomes for our members. This guide provides helpful information about MARCH® eligibility, benefits, claim submission, claimFRAME KIT CATALOGS
FRAME KIT CATALOGS. For a copy of your MARCH® Vision Care frame kit catalog, please select your state: Please note that not all states require the use of a MARCH® Vision Care frame kit. If your state does not require the use of a frame kit, you will not see your state listed above. If you have any questions, please contact our Provider ELECTRONIC PAYMENT/REMITTANCE MARCH® Vision Care partners with PaySpan® Health for Electronic Funds Transfers (EFTs) and Electronic Remittance Advices (ERAs). This service is FREE to MARCH® Vision Care providers. PaySpan® Health enables online presentment of remittance/vouchers and straight-forward reconciliation of payments to empower our providers to reduce costs, speed secondary billings, improve cash flow, and FORMS - MARCH VISION CARE FORMS. As part of our commitment to giving our providers convenient access to tools and resources, MARCH® Vision Care offers 24/7 access to the most current forms used by MARCH® Vision Care: IRS form W-9. Provider Demographics Form. Disclosure of Ownership and Control Interest Statement. Provider Dispute Resolution - Online Form.CREDENTIALING
CREDENTIALING AND RE-CREDENTIALING. All potential providers are required to complete an electronic Provider Credentialing Application or submit their CAQH number for credentialing. Initial applicants for the state of Kansas are required to apply directly through Kansas Medical Assistance Program (KMAP) web portal. Please click here: MARCH VISION CARE PROVIDER REFERENCE GUIDEMARCH VISION CARE PROVIDERMARCH PROVIDER NUMBEREYESYNERGY PROVIDER PHONE NUMBER MARCH® is committed to working with our contracted providers and their staff to achieve the best possible health outcomes for our members. This guide provides helpful information about MARCH® eligibility, benefits, claim submission, claim payments, and much more. For easy navigation through this guide, click on the Table of Contents to be taken to the section of FORMS - MARCH VISION CAREINFO MARCH VISION CAREINFO MARCH VISION DISCLOSURE OF OWNERSHIP AND CONTROL INTEREST STATEMENT. Please answer all questions on the form as of the current date. If additional space is needed, please note on the form that the answer is being continuedon a separate
LAB ORDER FORM INSTRUCTIONS Lab Order Form Please fax completed form to (855) 640-6737 MEMBER INFORMATION Member’s Name and Date of Birth: Today’s Date: Member’s ID Number: Date of MARCH VISION CAREJOIN OUR NETWORKICD-10 INFORMATIONCOMPLIANCE INFORMATIONPROVIDER RESOURCES MARCH specializes in the administration of vision care benefits for managed care organizations, specifically for government sponsored programs such as Medicaid, Medicare, Medicare-Medicaid Plans, and Healthcare Exchange. MARCH also offers a broad range of fully customizable vision care programs to meet the needs of small to mid-sized businesses, self-insured corporations, unionsPROVIDER RESOURCES
PROVIDER RESOURCES. For additional information regarding plan administration including coverage criteria, eligibility, claims, claim disputes and/or appeals, and much more, please refer to the Provider Reference Guide below. Provider Reference Guide. Compliance Information. ADDITIONAL RESOURCES: Cultural & Linguistics. MARCH VISION CARE PROVIDER REFERENCE GUIDE Provider Reference Guide | About the Provider Reference Guide MARCH® Vision Care | 3 About the Provider Reference Guide MARCH® is committed to working with our contracted providers and their staff to achieve the best possible health outcomes for our members. This guide provides helpful information about MARCH® eligibility, benefits, claim submission, claimFRAME KIT CATALOGS
FRAME KIT CATALOGS. For a copy of your MARCH® Vision Care frame kit catalog, please select your state: Please note that not all states require the use of a MARCH® Vision Care frame kit. If your state does not require the use of a frame kit, you will not see your state listed above. If you have any questions, please contact our Provider ELECTRONIC PAYMENT/REMITTANCE MARCH® Vision Care partners with PaySpan® Health for Electronic Funds Transfers (EFTs) and Electronic Remittance Advices (ERAs). This service is FREE to MARCH® Vision Care providers. PaySpan® Health enables online presentment of remittance/vouchers and straight-forward reconciliation of payments to empower our providers to reduce costs, speed secondary billings, improve cash flow, and FORMS - MARCH VISION CARE FORMS. As part of our commitment to giving our providers convenient access to tools and resources, MARCH® Vision Care offers 24/7 access to the most current forms used by MARCH® Vision Care: IRS form W-9. Provider Demographics Form. Disclosure of Ownership and Control Interest Statement. Provider Dispute Resolution - Online Form.CREDENTIALING
CREDENTIALING AND RE-CREDENTIALING. All potential providers are required to complete an electronic Provider Credentialing Application or submit their CAQH number for credentialing. Initial applicants for the state of Kansas are required to apply directly through Kansas Medical Assistance Program (KMAP) web portal. Please click here: MARCH VISION CARE PROVIDER REFERENCE GUIDEMARCH VISION CARE PROVIDERMARCH PROVIDER NUMBEREYESYNERGY PROVIDER PHONE NUMBER MARCH® is committed to working with our contracted providers and their staff to achieve the best possible health outcomes for our members. This guide provides helpful information about MARCH® eligibility, benefits, claim submission, claim payments, and much more. For easy navigation through this guide, click on the Table of Contents to be taken to the section of FORMS - MARCH VISION CAREINFO MARCH VISION CAREINFO MARCH VISION DISCLOSURE OF OWNERSHIP AND CONTROL INTEREST STATEMENT. Please answer all questions on the form as of the current date. If additional space is needed, please note on the form that the answer is being continuedon a separate
LAB ORDER FORM INSTRUCTIONS Lab Order Form Please fax completed form to (855) 640-6737 MEMBER INFORMATION Member’s Name and Date of Birth: Today’s Date: Member’s ID Number: Date of DOCTORS AND OFFICE STAFF Doctors and Office Staff. DOCTORS & OFFICE STAFF. Important Update on COVID-19. MARCH Vision Care’s top priorities are protecting the health of our members and the safety of those who deliver care. As this situation evolves, we are committed to adapting and supporting those we serve. Please know we are committed to business continuityand
HELP PAGE - MARCH VISION CARE Help. Welcome to the March Vision Care Website! If you are experiencing technical difficulties or just have a suggestion, please send an e-mail to marchsupport@marchvisioncare.com. Technical support is available Monday through Friday, 8:00 a.m. to 5:00 p.m. PST by contacting MARCH® Vision Cares's Customer Service Department. FORMS - MARCH VISION CARE DISCLOSURE OF OWNERSHIP AND CONTROL INTEREST STATEMENT. Please answer all questions on the form as of the current date. If additional space is needed, please note on the form that the answer is being continuedon a separate
PROVIDER REFERENCE GUIDE Provider Reference Guide: Louisiana only. Provider Reference Guide: Mississippi only. Provider Reference Guide: Tennessee only. Provider Reference Guide: Texas only. Provider Reference Guide: Kentucky only. For state specific information including benefits: Select a State ALASKA ALABAMA ARKANSAS ARIZONA CALIFORNIA COLORADO CONNECTICUTDISTRICT
LAB ORDER FORM INSTRUCTIONS Lab Order Form Please fax completed form to (855) 640-6737 MEMBER INFORMATION Member’s Name and Date of Birth: Today’s Date: Member’s ID Number: Date of QUICK REFERENCE GUIDE Provider Quick Reference Guide MARCH Vision Care (“MARCH”) administers the primary eye care benefit for UnitedHealthCare and Molina Healthcare’s Centennial Care Program for the Medicaid product. Interactive Voice Recognition SystemTABLE OF CONTENTS
New York Specific Information MARCH Vision Care Revised December 16, 2019 | Page 1 of 13 . This document contains information specific to the State of New York. Please refer toDEMOGRAPHICS FORM
Page 4 of 4 Demographics Form 11/19 By entering my name and date below, I attest to MARCH® Vision Care that the information contained in the attached application is true MARCH VISION CARE TEXAS PROVIDER REFERENCE GUIDE MARCH® is committed to working with our contracted providers and their staff to chieve the best possible health outcomes a for our members. This guide provides helpful information about MARCH® eligibility, benefits, claim submission, claim payments, and much more. For easy navigation through this guide, click on the Table of Contents to be taken to the section of 2019 ANNUAL COMPLIANCE AND FRAUD WASTE AND ABUSE TRAINING Page 2 of 2 workers and volunteers), the CEO, senior administrators or managers, governing body members, and sub-delegates who are involved in the administration or delivery eyeSynergy® : LOCATE A PROVIDER: CAREERS
: CONTACT US : ABOUT US IMPORTANT UPDATE ON COVID-19 Your health is our top priority. We’re taking action to support our members during this unprecedented time. MARCH Vision Care will work with and follow all COVID-19 guidance and protocols provided by the Centers for Disease Control and Prevention (CDC), and state and
local public health departments. We recommend you follow CDC guidance about doctor’s visits, including postponing routine eye care visits. Be sure to contact your doctor’s office directly to confirm office hours and appointments before seeking care. To learn more about COVID-19, go to CDC.gov .*
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