Does this practitioner have surgical privileges?

If yes, once an Onboarding Form has been completed, please complete a Versant Health Surgical Privileges Intake Form after the submission of this Versant Health Provider Onboarding Form.
Separate Onboarding Form(s) for each practitioner is still required.
A link will be provided after the submission of a Versant Health Provider Onboarding Form.

Medicaid and Medicare

Individual Medicaid and Medicare ID(s) and Location Medicaid and Medicare ID(s) are required to service Medicaid and/or Medicare plans¹. If pending or N/A, the practitioner and/or location will not be able to service Medicaid and/or Medicare plans until our systems are updated.

To update a participating practitioner and/or locations' Medicaid and/or Medicare ID, upload the state approval letter(s) and Provider Fee Schedule² by submitting a Provider Change Form³ located on the Provider Resource Center.

Valid Medicaid and/or a Medicare IDs are required for the practitioner to service Medicaid and/or Medicare plans.

^{1 For Ohio state providers, register with CVO. For Washington state providers, setup a OneHealthPort account. Opticians please input N/A.
2 Superior Vision Only. Will be provided after Onboarding submission.
3 Required for Davis Vision and/or Superior Vision Network - Located on the Provider Resource Center}

Practitioner's annual compliance certification(s) are a part of the Annual Certification of Statement for Provider Billing Medicaid Form. This certification is required to be submitted to eMedNY on the anniversary date of the provider’s enrollment in Medicaid.

Form sample here: eMedNY ETIN CERT FORM

Medicaid and Medicare

Individual Medicaid and Medicare ID(s) and Location Medicaid and Medicare ID(s) are required to service Medicaid and/or Medicare plans. If pending or N/A, the practitioner and/or location will not be able to service Medicaid and/or Medicare plans until our systems are updated.

To update a participating practitioner and/or locations' Medicaid and/or Medicare ID, upload the state approval letter(s) and Provider Fee Schedule¹ by submitting a Provider Change Form² located on the Provider Resource Center. 

Valid Medicaid and/or a Medicare IDs are required for location(s) to service Medicaid and/or Medicare plans.

^{1 Superior Vision Only. Will be provided after Onboarding submission.
2 Required for Davis Vision and/or Superior Vision Network - Located on the Provider Resource Center}

Note: For Exisiting Offices: Utilize the location field on the Eyecare Professional Portal to find the Provider/Office ID(s).
Input N/A if the office is not currently on the network

Medicaid and Medicare 

Individual Medicaid and Medicare ID(s) and Location Medicaid and Medicare ID(s) are required to service Medicaid and/or Medicare plans. If pending or N/A, the practitioner and/or location will not be able to service Medicaid and/or Medicare plans until our systems are updated.

To update a participating practitioner and/or locations' Medicaid and/or Medicare ID, upload the state approval letter(s) and Provider Fee Schedule¹ by submitting a Provider Change Form² located on the Provider Resource Center.

Valid Medicaid and/or a Medicare IDs are required for location(s) to service Medicaid and/or Medicare plans.

^{1 Superior Vision Only. Will be provided after Onboarding submission.
2 Required for Davis Vision and/or Superior Vision Network - Located on the Provider Resource Center}

As an In-Network provider, you may receive the Exclusive Frame Collection, an additional 222 or 48 Medicaid frames to your existing selection. A display of top-selling eyewear offered to members for low-to-no out-of-pocket cost. 
Subject to change based on demographics

For more information about Federally Qualified Health Centers, please visit https://www.fqhc.org/find-an-fqhc.