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Reimbursement California
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Reimbursement - California

VSP’s Doctor Payment System

For the VSP Signature Plan® and VSP Choice Plan® we reimburse doctors according to a unique fee payment methodology. Our goals are to pay doctors as fairly as we can while, at the same time, provide an eyecare plan to clients at a competitive price.

We pay professional fees for the VSP Signature Plan® and VSP Choice Plan® exams (diagnostic services) and lens and frame dispensing services. Refer to the VSP Signature Plan in the Plans and Coverages section for more information.

Filing Doctors’ Fees

Doctors’ usual and customary (U&C) fees are first filed with VSP during the Credentialing process. VSP uses this information to determine each doctor’s payable fees for providing services to VSP patients.

Assigned Fee Reports

Assigned Fee Reports (AFRs) reflect the doctor-submitted U&Cs and VSP-determined payable amounts for exams, basic lens, and frame services based on VSP Plan type. Access your Assigned Fee Report for your practice on VSPOnline at eyefinity.com by clicking the View Fees link under Practice/Doctor Updates in the Administration area.

Signature Network

Your VSP Signature Plan reimbursement schedule is contained in your Assigned Fee Report on VSPOnline. Check here to see your reported U&Cs and VSP-determined payable amounts for exams, basic lens, and frame services.

Choice Network

Your VSP Choice Plan reimbursement schedule is contained in your Assigned Fee Report on VSPOnline. Check here to see your reported U&Cs and VSP-determined payable amounts for exams, basic lens, and frame services.

Other Networks

Our VSP Advantage and Medicaid Plans have fee schedules for each state. View fee schedules for plans you participate with by accessing the appropriate Manual on VSPOnline.

Maximum Allowances

Our Board of Directors establishes maximum amounts that can be reimbursed for exams and for lens and frame services in each geographic region. The board reviews these confidential amounts when applicable.

Progressive Lenses (Signature, Choice and Advantage)

You will receive your bifocal dispensing fee PLUS a service fee for progressive lenses. If covered, both the bifocal dispensing and applicable service fee are paid by VSP. For all other progressives, see Lens Enhancements Charges Report for information on patient charges.

Payments

We deposit payment to your bank account via Electronic Funds Transfer (EFT) following your state’s established pay schedule and include payment for claims turned in and received during specified pay periods. An Explanation of Payments (EOP) itemizing the claims paid with checks and post statements is available to view on VSPOnline.

Important! 

All VSP payments will be made by EFT, also known as direct deposit. Network doctors must be enrolled in order to receive payment. Doctors can enroll their practice online or by contacting Customer Service at 800.615.1883.

Cutoff Dates

Our payment schedule includes cutoff dates; claims need to be processed by these dates for them to be paid on your next check. Cutoffs usually fall five to 10 days before the last day of the payment period. We can’t guarantee internal processing time, but claims turned in at least five working days before the cutoff usually are paid on the upcoming check.

Telehealth

VSP will reimburse covered services provided via telehealth on the same basis and to the same extent as covered services delivered in-person.