All of Network Doctor’s performance data, services and materials provided to VSP Patients, and claims submitted to VSP, are subject to review and audit. Upon request, and at their own expense, a Network Doctor must furnish patient records, in the time frame requested, to VSP or any or all Enrollees for whom claims have been submitted to VSP for payment. Network Doctor shall fully cooperate with any VSP review or audit activity, including, without limitation, in-office audits and inspections, business audits, special investigation audits, medical record reviews and all similar VSP investigative or quality assurance efforts. For quality and authentication purposes, Network Doctor understands and agrees that some audits may be unannounced. Network Doctor shall not refuse to permit an audit because an audit was not announced in advance, may be disruptive or for any other reason. Should Network Doctor refuse to permit an audit for any reason, Network Doctor may be subject to termination for failure to comply with the Network Doctor Agreement and/or restitution in an amount to be determined by VSP. Network Doctor agrees to cooperate with, abide by, and adhere to, all rulings of any VSP quality assurance or peer review committee. All records, data and information acquired by or prepared for any VSP quality assurance or peer review committee shall be held in confidence, except to the extent necessary to carry out the purposes of such review activities, and shall not be subject to subpoena or discovery, except as may be required by law or as otherwise required in the Agreement.

The confidentiality requirements set forth above, shall survive the expiration or termination of the Network Doctor Agreement Network Doctor further agrees that upon request, Network Doctor will timely furnish case records to VSP of any or all Enrollees for whom claims have been submitted, and that VSP may use any information so obtained for statistical, actuarial, scientific, peer review or other reasonable purposes, including applicable state and federal law requirements, provided that no professional confidence shall be breached thereby. Network Doctor also agrees that utilization and claims information may be released to MCOs and peer review groups. The confidentiality of VSP Patient medical information shall not be compromised. Network Doctor shall reimburse VSP in a timely manner for its reasonable out-of-pocket expenses and costs incurred in audit(s)/inspection(s) resulting in restitution due to improper billing. These costs shall include the reasonable market value of the time spent by VSP's Special Investigative Unit or Provider Quality Auditors for travel to and from the practice being audited, for recovery of necessary records, to conduct the audit, and the reasonable market value of the time spent to review and finalize the audit results.

While VSP encourages the use of the Well Vision Savings Statement to show VSP’s value to the patient, it does not constitute an acceptable financial record for audit purposes. In accordance with VSP policy, all financial records must be itemized for the services and/or materials provided to the patient, regardless of whether the patient incurred any out-of-pocket expenses. The financial record keeping should include the appropriate CPT/HCPC codes and descriptions, quantities, and the amounts billed to and paid by the patient and insurers (including coordination of benefits).

CONTACT LENSES

Itemized financial records must be kept for all VSP patients and must include the following for visually necessary, covered and elective contact lenses:

• Patient name
• Date of service
• CL brand
• Type
• Quantity and date dispensed
• U&C cost for services (fitting and evaluation)
• U&C cost for materials
• Amount billed to insurance
• Amount paid by the patient
• Method of payment
• Material manufacture invoice(s) or indication of dispensing from stock

Under the Visually Necessary Contact Lens plan benefit, the patient is only charged the appropriate copayment, but you must still keep itemized records as noted above.

When billing VSP for contact lenses, you must keep a list of U&C fees and costs for services and materials for reference. This must be shown and a copy provided to any VSP Representative upon request.

GLASSES

Itemized financial records must be kept for all VSP patients and must include the following for glasses:

• Patient name
• Date of service
• Lens type
• Lens options
• Frame make, model and retail cost
• Frame invoices with acquisition costs
• Date dispensed
• Amount billed to insurance
• Amount paid by the patient
• Method of payment
• Material order(s) and lab invoice(s)

Failure to keep and provide itemized records for any services or materials rendered may result in the denial of payment for billed services and materials.