1 This list does not provide all information to be listed on the application, the application will require additional basic information such as name, address etc. Please supply a certified English translation for any foreign language documentation.
2 Canopy reserves the right to immediately terminate or suspend this Agreement if you fail to provide the requisite certification and verification within the time period specified herein
3 Optical centers should have confirmed coverage from a licensed Optometrists/Ophthalmologist for at least 12 hours per week at each location. Confirmation of this schedule should be presented within 60 days after onboarding.
4 Canopy reserves the right to require additional documents or to conduct a site visit which may delay the onboarding process. Canopy also reserves the right to deny providers access to its network if it so chooses at its own discretion.
5 All paper claim forms should be submitted within 90 days of the date of service. Please note that pharmacy claims will only be processed electronically.