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Billing terms and conditions template for Animal science

[Music] welcome to the webinar on the non insured health benefits vision care enrollment package for vision care providers who wish to submit claims to the nhb program for providing services to NHB clients the vision care enrollment package is located on the NAHB provider and client website providers are recommended to first create an NH 3 web account download the forms and complete them on their electronic device once all mandatory fields labeled with an asterisk are completed and the forms are dated and signed by the provider the provider can submit the forms through their NHP web account to Express Scripts Canada for processing alternatively providers can print all forms directly from the website complete them manually and then submit them by fax or mail using the information located at the top of each form the vision care enrollment package contains a mandatory vision care of billing agreement and two optional forms for providers to specify an alternate mailing address with their preferred method of communication and a form for direct deposit payments to learn more about the available optional forms providers are encouraged to view the Vision Care optional forms webinar providers who wish to submit the vision care enrollment package through their nhb web account must first sign into their account select the benefit that they wish to enroll for then either click the upload button or drag and drop the file to the upload area this process is for providers who choose to download and complete the forms on their electronic device or who print the forms manually complete and sign it then scan and save them back to their computer once the vision care enrollment package has been completed and checked for accuracy the provider must sign page 1 also known as the Vision Care billing agreement using an electronic signature please follow the prompts provided by the Adobe software to create your electronic signature once the provider adds their electronic signature no information can be changed if a change is required the provider will need to remove their electronic signature make the update and then resign electronically there are a few sections in particular we would like to draw your attention to there was a clear and print button at the top right-hand side of the page this clear button will clear all fields and set the entire Vision Care billing agreement back to blank the print button allows the provider to print the forms providers who choose to enroll as an owner must indicate their operating name and legal business name an example of an operating name is john doe's optical an example of a legal business name is 1 2 3 4 5 Ontario limited providers who choose to enroll as an associate must indicate their first and last name operating name and legal business name an example of an operating name for an associate is John Doe in this section the provider must select a specialty that they are licensed to practice you must select at least one option providers must attach all valid copies of licenses school diplomas and degrees regulatory body Association or training certificates with a specialty at the time of enrollment NHP program requires verification that the provider is in good standing and writers must maintain the status in order to enroll in the nhb program the service location is the public business address where the services for NIH be clients will be provided providers must indicate at least one service location address do not use the providers personal mailing address here an alternate address can be added by completing the alternate mailing address communication preference form providers are to include a phone number for Express Scripts Canada to contact when necessary the question on the Vision Care billing agreement as any owner officer or director ever been denied a provide a number or had it revoked from NIH B or any plan is asking whether the provider and/or any owner officer or director have previously been denied access to the NH B program or any health care plan the provider must select either yes or no if yes is selected the provider must indicate in the text box the reason for denial and for which healthcare play in order to participate in the NIH B program providers must review the terms and conditions which are located on the second and third pages of the billing agreement if providers require further clarification on how to upload the Vision Care billing agreement to the NIH B web account please contact a non insured health benefits call center at Express Scripts Canada at one eight eight eight five one one four six six six thank you for viewing the NH B Vision Care billing agreement tutorial