OptiCare® Managed Vision Providers login page

Welcome Eye Health Manager Login Online Forms Education Join the OptiCare Network Contact Us Update Email Address	Forms Advanced Beneficiary Notice (ABN) (PDF) All States Provider Address Form (PDF) All States W-9 (PDF) Allowed Facilities for Baptist Health AvMed Members (PDF) Claims Appeal Request Form (PDF) Claims Status Request Form (PDF) CuraScript Referral Form (PDF) Non-Covered Services Liability Acknowledgement (PDF) On-Line Access Request (Link) Panel Participation Request Form (PDF) Pre-Authorization Request (PDF) Pre-Authorization Request for AvMed Members (PDF) Pre-Authorization Request for Kentucky Spirit Members (PDF) Pre-Authorization Request for Louisiana Healthcare Connections Members (PDF) Pre-Authorization Request for Texas (PDF) Prior Notification Form (PDF) Provider Update Form (PDF) Statement of Controlled Substance Coverage (PDF) UPMC Health Plan Non-Covered Services Agreement (PDF) Waiver of Liability Form (PDF)
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. For your protection, our privacy policy prevents us from responding to emails containing protected health information (specific information about you and your healthcare) because we cannot guarantee the security of these e-mails before they reach us. Please contact your customer service representative should you have questions or concerns regarding your eye care services.