Opticare Home Page
FORMS

General Forms
All States Provider Address Form
All States W-9
On-Line Eye Health Manager Request Form
Claims Appeal Request Form
Claims Status Request Form
Fee Schedules
Panel Participation Request Form
Waiver of Liability Form
Prior Notification Form
Advanced Beneficiary Notice (ABN)
Provider Update Form
Member Liability Acknowledgement

Submission of credentialing materials does not guarantee the processing or approval of your participation with OptiCare Managed Vision / AECC-Total Vision Health Plan of Texas, Inc.  All submitted materials will be reviewed and responded to accordingly.

 

 

 

 

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