Maui Jim
Effective September 1, 2023, Maui Jim will discontinue ophthalmic (clear) lenses and ophthalmic frames to focus on Suns. The last day practices can submit Maui Jim clear lens orders to the Maui Jim lab is August 31, 2023. If you have questions, please reach out to your Maui Jim Account Executive.
VSP network doctors who are authorized Maui Jim retailers can continue to submit Maui Jim claims and orders through eyefinity.com (or through any of Eyefinity’s practice management systems) and VSP patients can use their standard lens and frame coverage towards genuine Maui Jim sunglasses (prescription or plano based on patient’s plan). Please refer to the guidelines below when patients select Maui Jim materials.
Applying Benefits
VSP patients can use their lens and frame coverage towards genuine Maui Jim Lenses, including Maui Jim sunglass lenses.
- Standard benefit coverage applies to determine patient out-of-pocket expenses. Please refer to the Patient Record Report to verify the patient’s coverage details for lens, lens enhancements and frame.
- Apply the patient’s coverage to the Maui Jim lens and frame following coverage details.
- Review the Product Index for lens enhancements codes and
Lab
Maui Jim Lab (authentic lenses)
- Maui Jim Lab will appear in the contract lab list as #584, which is located in Peoria, IL.
- Sunglass frame orders should only go to Maui Jim Lab. Sunglass orders fabricated at any other lab will void the frame warranty.
- Non-Maui Jim prescription lenses and frames will not be processed.
VSP contract lab (non-authentic lenses)
- Sunglass orders fabricated at a non-Maui Jim lab will void the frame warranty.
Submitting Claims/Billing
Maui Jim Lens and Frame
- On the Lab Invoice, select Lab Finishing and enter the lens type and lens enhancements, as needed.
- Select the Maui Jim Lab (0584)
- All genuine Maui Jim sunglass lens and sunglass frame orders must be sent to Maui Jim.
3. Complete the prescription section with the patient’s Rx information
4. Search for the Maui Jim frame to order. Be sure you select the appropriate frame SKUs for prescription vs. non-prescription orders:
- Rx Sunglasses: Frames for Maui Jim sunglass prescription orders must begin with “Mjrx” in the color description. Frame model will typically display the frame name followed by 3 digits.
- If you have verified with Maui Jim that the frame is Rx-able, you may edit the frame details to include “Mjrx” at the beginning.
- Plano Sunglasses: Ready-made Maui Jim sunglasses will display the frame name followed by 3 digits. Ready-made sunglasses have a higher wholesale cost due to the Maui Jim plano sunglasses lenses included with the frame.
Important!
Make sure you select the appropriate SKU. Mjrx is a designation that belongs to only sunglass frames that can be processed in the Maui Jim lab. Sunglass frames without Mjrx include plano Maui Jim lenses and have a higher wholesale cost.
5. Verify the wholesale cost populates in the search results.
- Wholesale costs may vary between Rx and non-Rx sunglass frames.
- Do not change the wholesale cost that populates in eClaim (or eLab). These have been provided by Maui Jim to ensure accurate billing and claim payment by VSP.
Important!
Changing the value may result in your order being voided by Maui Jim to reenter correctly or an incorrect VSP claim payment.
- If there is no wholesale value listed, check the frame spelling/casing and retry the search.
Example:
Pearl City 214 will return an outdated SKU and no wholesale whereas PEARL CITY 214 populated the correct SKU and wholesale amount.
6. Select one of the following options from the Supplier drop-down menu:
- Lab Supplied – new complete order (lens and frame), billed from Maui Jim to VSP.
- Patient Supplied - To Come – when shipping a frame that patient purchased privately
- Doctor Supplied - To Come – when shipping a frame to the lab that is being billed under patient’s insurance benefits; if frame is purchased from Maui Jim at the time of submitting the order, the account will be billed by Maui Jim for the frame.
7. Follow the instructions below regarding special instructions for the lab:
- Do not select the Lab Special Instructions check box. Although you can view any special instructions that you record in eClaim on the order reports, they are not sent to the Maui Jim lab
8. Select Calculate and Continue to proceed to filing your VSP claim.
Important!
Do not enter “Proprietary” in the Special Instructions box (CMS1500 box 19). This will cause the claim to revert to private lab during claim processing and you will be responsible for the lab bill.
Maui Jim Sunglass Frame with Non-authentic Sunglass Lenses
If patient selects a Maui Jim sunglass frame but does not wish to have authentic Maui Jim sunglass lenses, obtain an authorization and select the desired VSP contract lab to submit the lens and frame (patient or doctor supplied).
- Non-authentic sunglass lenses fabricated at non-Maui Jim labs will void the frame warranty.
Reimbursement
Lens and Frame payments follow standard VSP payment guidelines.
Warranty
Maui Jim offers a limited warranty on lenses and frames as a supplement to any applicable VSP warranty. For questions on the Maui Jim warranty, 1-833-MJRXVSP (657-9877).
Includes:
- Complimentary temple and nose pad replacement as long as parts are available
- One-year one-time scratch warranty on sun lenses
Exclusions:
- Void if original lenses or frames are altered
- Does not apply to normal wear
- Does not cover shipping costs
Common Scenarios
This isn’t a complete list of unique situations. Please refer to the additional resources in the Provider Reference Manual and/or User Guides in Eyefinity eLearn Tab for additional billing instructions.
Scenario Description |
Billing Tips |
---|---|
Ordering authentic Maui Jim lenses |
|
Ordering non-authentic sunglass lenses for Maui Jim frame |
Generic lens orders can be sent to any VSP contracted lab:
|
Maui Jim Lens Guide |
Refer to the following Maui Jim style guide. |
Identifying frames for prescription sunglass orders |
Frames for Maui Jim prescription sun orders must begin with Mjrx in the color description. |
Identifying ophthalmic frames |
Maui Jim ophthalmic frames begin with MJO in the color description. No longer available effective September 1, 2023. |
Determining the wholesale cost |
Do not change the wholesale cost that populates in eClaim (or eLab).
|
Selecting Frame Supplier |
Lab Supplied – new complete order (lens and frame).
Patient Supplied - To Come – when shipping a frame that patient purchased privately (or if ordering generic lenses to non-Maui Jim lab). Doctor Supplied - To Come – when shipping a frame to the lab that is being billed under patient’s insurance benefits.
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