We contract with optical labs throughout the United States to manufacture prescription orders submitted by VSP network doctors. Claim payment for orders with materials will only be processed after the contract lab completes a prescription and submits the claim to VSP for payment.

1. Submit orders to contract labs through eClaim or on paper using the CMS-1500 form and Materials Invoice. Include all prescription information. You can choose any lab on the National Contract Lab List.
2. Charge your patients for lens enhancements unless their plans say otherwise. For these lens enhancements, VSP lab allocations are deducted from your reimbursement to pay the lab (see VSP Signature Lens Enhancements Chart for more information).
3. The lab will ship the completed order to you and forward your claim to VSP for payment.

Using Non-Contract Labs

You can only use non-contract labs in emergencies. VSP monitors the use of non-contract labs and they may only be used in the situations below.

Examples of emergencies include:

• Loss, theft, or breakage of prescription eyewear when your patient doesn’t own an alternate pair and can’t wear contact lenses
• Situations where your patient can’t function at work or school and doesn’t have another pair of glasses or contact lenses
• Patients whose safety and well-being will be jeopardized without the immediate delivery of their prescription eyewear

Emergency situations don’t include:

• Instances where faster turn-around time is requested to accommodate trips, vacations, or other discretionary events
• Providing faster service when your patient has another functional pair of glasses or contacts

To submit a claim when a non-VSP lab is used, select Non-IDC Lab Invoice (Lab 0100) from the pull-down menu in the Lab Selection box on eClaim or write “Non-IDC Lab Invoice (Lab 0100)” in the Special Instructions area of the Materials Invoice. When submitting an emergency claim, please specify the emergency reason. Selecting an emergency reason is for documentation purposes; not selecting a reason does not remove the emergency requirement.

All Lab invoices must be kept for a minimum of seven (7) years. Failure to keep Lab invoices may result in the denial of services and materials.

Lab invoices from an outside private lab must include the following:

• Patient name
• Date ordered/date completed
• Rx
• Lens enhancements
• Style and frame type, including make and model

You’ll be responsible for the entire cost of the lab bill and should pay the lab on a private-transaction basis. Don’t charge the patient for covered lens enhancements, you won’t receive a service fee for covered lens enhancements. For all other lens enhancements, charge the patient according to their plan. You won’t receive a VSP lab allocation for these lens enhancements. VSP will pay you an established fee of $10.50 for single vision, $23.50 for bifocal/progressive and $33.50 for trifocal, in addition to your regular dispensing fees. Use your bifocal lens-dispensing fee for progressives. Charge your patient according to the VSP Signature Lens Enhancements Chart or your adjusted U&C fee (whichever is lower). Don’t balance-bill the patient.

All emergency orders are subject to review. When a claim is found to be incorrect, payments for material services will be reversed.

Uncuts

Uncut lenses can only be processed in the case of an emergency. Submit as a private order. The lab will bill their U&C fees. This should only be done on very rare occasions.

You can order the following on a private-transaction basis:

• Proprietary Lens and Frame (see Proprietary Lens and Frame in this section)
• Plano lenses (if not covered by your patient’s plan)
• Additional pairs of glasses using the value-added benefit (80% or 70% of U&C unless covered by your patient’s plan—refer to Section 2—Plans and Coverages for more information about additional pairs of glasses)

Certain single vision stock lenses may be finished in your office through the VSP In-Office Finishing Program. Refer to the VSP In-Office Finishing Program section of the manual for complete details.

A Lab order form and/or invoice are required for in-office jobs as well. These invoices must include the following:

• Patient name
• Date ordered/date completed
• Rx
• Lens enhancements
• Style and frame type, including make and model

Records must also include the date when the glasses were dispensed to the patient.