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Vision Services

Medical Coverage Guidelines

Medicaid Vision Manual pdf image

Please note that coverage guidelines and procedures are subject to change. Refer to the monthly Provider Update for recent changes.

Claim Preparation Instructions

CMS 1500 Form Filing Instructions pdf image
Vision Services - CMS 1500 Claim Form pdf image

Error Status Codes

ESC Code List (English) pdf image

Explanation of Benefits (EOB) Codes

EOB Codes and Messages List (English) pdf image
EOB Codes and Messages List (Spanish)

Appendix - Third Party Liability Carrier and Coverage Codes

Third Party Liability (TPL) Carrier Codes pdf image
Third Party Liability (TPL) Coverage Codes

For specific questions you may contact the Customer Service Help Desk at (401) 784-8100 for In-state and long distance callers, or 1-800-964-6211 for In-state toll callers and border communities.



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