Apply To Join Our Network

Please follow the link to complete a Versant Health Surgical Privileges Intake Form.

Versant Health Surgical Privileges Intake Form
An Onboarding Form for each practitioner and service location is still required.

Medicaid and Medicare

A valid Medicaid and/or a Medicare ID is required for the practitioner to service Medicaid and/or Medicare plans.

To update a practitioner’s Medicaid and/or Medicare ID after an initial credentialing application has been submitted, send the state approval letter(s), Provider Change Form and Fee Schedule to the Network Operations Department at 210-245-2369 to have that department update the practitioner’s file.

If an existing Superior Vision practice has been purchased, a Bill of Sale, W-9 Form and Provider Change Form will be requested and is required to update our systems.

Location Medicaid and Medicare ID(s), if pending or N/A

To update a location Medicaid and/or Medicare ID after an initial credentialing application has been submitted, send the state approval letter(s), Provider Change Form and Fee Schedule* to the Network Operations Department at 210-245-2369 to have that department update the location(s) information in our systems.

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

*Superior Vision Only

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

Location(s) Medicaid and Medicare ID(s)

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

To update location(s) Medicaid and/or Medicare ID after an initial credentialing application has been submitted, send the state approval letter(s), Provider Change Form and Fee Schedule to the Network Operations Department at 210-245-2369 to have that department update the location(s) file.

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.