NOTE: This manual remains the sole and exclusive property of VSP®. The information contained in this manual is confidential and proprietary, and the VSP network provider is granted a limited personal and nontransferrable license for use of the content of this manual during participation on the VSP network. The contents of this manual may not be used, copied, and/or reproduced for any other purpose, or disclosed and/or disseminated to any third party for any purpose whatsoever, without the prior written consent of VSP. If, for any reason, the manual recipient no longer participates on the VSP network, the doctor hereby agrees, and is directed, to immediately destroy this manual, all copies, and any and all amendments and addenda that may be issued by VSP from time to time.
medicaid plan Table of content
VSP’s Medicaid Plan
Enrollment/Doctor Participation
Exam Coverage
Materials Coverage
Laboratory
Submitting Claims/Billing, Reimbursement, & Appeals
Medicaid Client Details
Medicaid Fee Schedules
VSP’s Medicaid Plan
This material is confidential, intended for the use of VSP Vision doctors only. The contents may not be shared with any unauthorized person. This manual is the property of VSP Vision.
VSP’s Medicaid Plan
Confidential
VSP’s Medicaid Plan (AZ)
VSP’s Medicaid Plan is based on contracts with health care organizations (clients) to provide the vision care portion of the state’s Medicaid program.
Clients are required to provide the minimum benefits specified by your state’s Medicaid program, but may also offer enhanced benefits.
Please refer to Client Detail pages and/or Medicaid Fee Schedules for details about administration of basic state benefits. For state information, refer to the State Medicaid Manual.
VSP’s Medicaid Plan (CA)
VSP’s Medicaid Plan is based on contracts with health care organizations (clients) to provide the vision care portion of the state’s Medicaid program.
Clients are required to provide the minimum benefits specified by your state’s Medicaid program, but may also offer enhanced benefits.
Please refer to Client Detail pages and/or Medicaid Fee Schedules for details about administration of basic state benefits. For state information, refer to the State Medicaid Manual.
VSP’s Medicaid Plan (IL)
VSP’s Medicaid Plan is based on contracts with health care organizations (clients) to provide the vision care portion of the state’s Medicaid program.
Clients are required to provide the minimum benefits specified by your state’s Medicaid program, but may also offer enhanced benefits.
Please refer to Client Detail pages and/or Medicaid Fee Schedules for details about administration of basic state benefits. For state information, refer to the State Medicaid Manual.
VSP’s Medicaid Plan (MI)
VSP’s Medicaid Plan is based on contracts with health care organizations (clients) to provide the vision care portion of the state’s Medicaid program.
Clients are required to provide the minimum benefits specified by your state’s Medicaid program, but may also offer enhanced benefits.
Please refer to Client Detail pages and/or Medicaid Fee Schedules for details about administration of basic state benefits. For state information, refer to the State Medicaid Manual
VSP’s Medicaid Plan (NV)
VSP’s Medicaid Plan is based on contracts with health care organizations (clients) to provide the vision care portion of the state’s Medicaid program.
Clients are required to provide the minimum benefits specified by your state’s Medicaid program, but may also offer enhanced benefits.
Please refer to Client Detail pages and/or Medicaid Fee Schedules for details about administration of basic state benefits. For state information, refer to the State Medicaid Manual.
VSP’s Medicaid Plan (NH)
VSP’s Medicaid Plan is based on contracts with health care organizations (clients) to provide the vision care portion of the state’s Medicaid program.
Clients are required to provide the minimum benefits specified by your state’s Medicaid program, but may also offer enhanced benefits.
Please refer to Client Detail pages and/or Medicaid Fee Schedules for details about administration of basic state benefits. For state information, refer to the State Medicaid Manual.
VSP’s Medicaid Plan (NY)
VSP’s Medicaid Plan is based on contracts with health care organizations (clients) to provide the vision care portion of the state’s Medicaid program.
Clients are required to provide the minimum benefits specified by your state’s Medicaid program, but may also offer enhanced benefits.
Please refer to Client Detail pages and/or Medicaid Fee Schedules for details about administration of basic state benefits. For state information, refer to the State Medicaid Manual.
VSP’s Medicaid Plan (OH)
VSP’s Medicaid Plan is based on contracts with health care organizations (clients) to provide the vision care portion of the state’s Medicaid program.
Clients are required to provide the minimum benefits specified by your state’s Medicaid program, but may also offer enhanced benefits.
Please refer to Client Detail pages and/or Medicaid Fee Schedules for details about administration of basic state benefits. For state information, refer to the State Medicaid Manual.
VSP’s Medicaid Plan (OR)
VSP’s Medicaid Plan is based on contracts with health care organizations (clients) to provide the vision care portion of the state’s Medicaid program.
Clients are required to provide the minimum benefits specified by your state’s Medicaid program, but may also offer enhanced benefits.
Please refer to Client Detail pages and/or Medicaid Fee Schedules for details about administration of basic state benefits. For state information, refer to the State Medicaid Manual.
VSP’s Medicaid Plan (SC)
VSP’s Medicaid Plan is based on contracts with health care organizations (clients) to provide the vision care portion of the state’s Medicaid program.
Clients are required to provide the minimum benefits specified by your state’s Medicaid program, but may also offer enhanced benefits.
Please refer to Client Detail pages and/or Medicaid Fee Schedules for details about administration of basic state benefits. For state information, refer to the State Medicaid Manual.
VSP’s Medicaid Plan (UT)
VSP’s Medicaid Plan is based on contracts with health care organizations (clients) to provide the vision care portion of the state’s Medicaid program.
Clients are required to provide the minimum benefits specified by your state’s Medicaid program, but may also offer enhanced benefits.
Please refer to Client Detail pages and/or Medicaid Fee Schedules for details about administration of basic state benefits. For state information, refer to the State Medicaid Manual.
VSP’s Medicaid Plan (VA)
VSP’s Medicaid Plan is based on contracts with health care organizations (clients) to provide the vision care portion of the state’s Medicaid program.
Clients are required to provide the minimum benefits specified by your state’s Medicaid program, but may also offer enhanced benefits.
Please refer to Client Detail pages and/or Medicaid Fee Schedules for details about administration of basic state benefits. For state information, refer to the State Medicaid Manual.
VSP’s Medicaid Plan (WA)
VSP’s Medicaid Plan is based on contracts with health care organizations (clients) to provide the vision care portion of the state’s Medicaid program.
Clients are required to provide the minimum benefits specified by your state’s Medicaid program, but may also offer enhanced benefits.
Please refer to Client Detail pages and/or Medicaid Fee Schedules for details about administration of basic state benefits. For state information, refer to the State Medicaid Manual.
VSP’s Medicaid Plan (WV)
VSP’s Medicaid Plan is based on contracts with health care organizations (clients) to provide the vision care portion of the state’s Medicaid program.
Clients are required to provide the minimum benefits specified by your state’s Medicaid program, but may also offer enhanced benefits.
Please refer to Client Detail pages and/or Medicaid Fee Schedules for details about administration of basic state benefits. For state information, refer to the State Medicaid Manual.
VSP’s Medicaid Plan (TX)
VSP’s Medicaid Plan is based on contracts with health care organizations (clients) to provide the vision care portion of the state’s Medicaid program.
Clients are required to provide the minimum benefits specified by your state’s Medicaid program, but may also offer enhanced benefits.
Please refer to Client Details pages and/or Medicaid Fee Schedules for details about administration of basic state benefits. For state information, refer to the State Medicaid Manual.
Enrollment/Doctor Participation
This material is confidential, intended for the use of VSP Vision doctors only. The contents may not be shared with any unauthorized person. This manual is the property of VSP Vision.
VSP’s Medicaid Plan
This material is confidential, intended for the use by VSP doctors only. The contents may not be shared with any unauthorized person. This manual is the property of VSP.
Enrollment/Doctor Participation (AZ)
Participation is voluntary. Only VSP doctors who have signed a Medicaid Plan Acknowledgment may provide services to Medicaid Plan members. All participating doctors are required to have a state Medicaid identification number.
Enrollment/Doctor Participation (CA)
Participation is voluntary. Only VSP doctors who have signed a Medicaid Plan Acknowledgment may provide services to Medicaid Plan members. All participating doctors are required to have a state Medicaid identification number.
Enrollment/Doctor Participation (IL)
Participation is voluntary. Only VSP doctors who have signed a Medicaid Plan Acknowledgment may provide services to Medicaid Plan members. All participating doctors are required to have a state Medicaid identification number.
Enrollment/Doctor Participation (MI)
Participation is voluntary. Only VSP doctors who have signed a Medicaid Plan Acknowledgment may provide services to Medicaid Plan members. All participating doctors are required to have a state Medicaid identification number.
Enrollment/Doctor Participation (NV)
Participation is voluntary. Only VSP doctors who have signed a Medicaid Plan Acknowledgment may provide services to Medicaid Plan members. All participating doctors are required to have a state Medicaid identification number.
Enrollment/Doctor Participation (NH)
Participation is voluntary. Only VSP doctors who have signed a Medicaid Plan Acknowledgment may provide services to Medicaid Plan members. All participating doctors are required to have a state Medicaid identification number.
Enrollment/Doctor Participation (NY)
Participation is voluntary. Only VSP doctors who have signed a Medicaid Plan Acknowledgment may provide services to Medicaid Plan members. All participating doctors are required to have a state Medicaid identification number.
Enrollment/Doctor Participation (OH)
Participation is voluntary. Only VSP doctors who have signed a Medicaid Plan Acknowledgment may provide services to Medicaid Plan members. All participating doctors are required to have a state Medicaid identification number.
Enrollment/Doctor Participation (OR)
Participation is voluntary. Only VSP doctors who have signed a Medicaid Plan Acknowledgment may provide services to Medicaid Plan members. All participating doctors are required to have a state Medicaid identification number.
Enrollment/Doctor Participation (SC)
Participation is voluntary. Only VSP doctors who have signed a Medicaid Plan Acknowledgment may provide services to Medicaid Plan members. All participating doctors are required to have a state Medicaid identification number.
Enrollment/Doctor Participation (UT)
Participation is voluntary. Only VSP doctors who have signed a Medicaid Plan Acknowledgment may provide services to Medicaid Plan members. All participating doctors are required to have a state Medicaid identification number.
Enrollment/Doctor Participation (VA)
Participation is voluntary. Only VSP doctors who have signed a Medicaid Plan Acknowledgment may provide services to Medicaid Plan members. All participating doctors are required to have a state Medicaid identification number.
Enrollment/Doctor Participation (WA)
Participation is voluntary. Only VSP doctors who have signed a Medicaid Plan Acknowledgment may provide services to Medicaid Plan members. All participating doctors are required to have a state Medicaid identification number.
Enrollment/Doctor Participation (WV)
Participation is voluntary. Only VSP doctors who have signed a Medicaid Plan Acknowledgment may provide services to Medicaid Plan members. All participating doctors are required to have a state Medicaid identification number.
Enrollment/Doctor Participation (TX)
Participation is voluntary. Only VSP doctors who have signed a Medicaid Plan Acknowledgment may provide services to Medicaid Plan members. All participating doctors are required to have a state Medicaid identification number.
All providers who serve Medicaid patients are required to complete and attest to having completed cultural competency training annually. Network doctors who own their practice are required to attest that they and their staff, including all employee doctors, completed the training. VSP makes this training available on VSPOnline and sends via email annually. You may take it at any time at least once per calendar year. The training modules include:
- Cultural Competency
- Better Communication, Better Care: Provider Tools to Care for Diverse Populations
- Seniors and Persons with Disabilities
- Patients’ Rights and Responsibilities
If you completed cultural competence training from another source, you may attest to that in lieu of taking VSP-provided training. The attestation is available on VSPOnline in the Cultural Competency training section or can be accessed from the link in the annual email reminder.
(AZ)
All providers who serve Medicaid patients are required to complete and attest to having completed cultural competency training annually. Network doctors who own their practice are required to attest that they and their staff, including all employee doctors, completed the training. VSP makes this training available on VSPOnline and sends via email annually. You may take it at any time at least once per calendar year. The training modules include:
- Cultural Competency
- Better Communication, Better Care: Provider Tools to Care for Diverse Populations
- Seniors and Persons with Disabilities
- Patients’ Rights and Responsibilities
If you completed cultural competence training from another source, you may attest to that in lieu of taking VSP-provided training. The attestation is available on VSPOnline in the Cultural Competency training section or can be accessed from the link in the annual email reminder.
(CA)
All providers who serve Medicaid patients are required to complete and attest to having completed cultural competency training annually. Network doctors who own their practice are required to attest that they and their staff, including all employee doctors, completed the training. VSP makes this training available on VSPOnline and sends via email annually. You may take it at any time at least once per calendar year. The training modules include:
- Cultural Competency
- Better Communication, Better Care: Provider Tools to Care for Diverse Populations
- Seniors and Persons with Disabilities
- Patients’ Rights and Responsibilities
If you completed cultural competence training from another source, you may attest to that in lieu of taking VSP-provided training. The attestation is available on VSPOnline in the Cultural Competency training section or can be accessed from the link in the annual email reminder.
(IL)
All providers who serve Medicaid patients are required to complete and attest to having completed cultural competency training annually. Network doctors who own their practice are required to attest that they and their staff, including all employee doctors, completed the training. VSP makes this training available on VSPOnline and sends via email annually. You may take it at any time at least once per calendar year. The training modules include:
- Cultural Competency
- Better Communication, Better Care: Provider Tools to Care for Diverse Populations
- Seniors and Persons with Disabilities
- Patients’ Rights and Responsibilities
If you completed cultural competence training from another source, you may attest to that in lieu of taking VSP-provided training. The attestation is available on VSPOnline in the Cultural Competency training section or can be accessed from the link in the annual email reminder.
(MI)
All providers who serve Medicaid patients are required to complete and attest to having completed cultural competency training annually. Network doctors who own their practice are required to attest that they and their staff, including all employee doctors, completed the training. VSP makes this training available on VSPOnline and sends via email annually. You may take it at any time at least once per calendar year. The training modules include:
- Cultural Competency
- Better Communication, Better Care: Provider Tools to Care for Diverse Populations
- Seniors and Persons with Disabilities
- Patients’ Rights and Responsibilities
If you completed cultural competence training from another source, you may attest to that in lieu of taking VSP-provided training. The attestation is available on VSPOnline in the Cultural Competency training section or can be accessed from the link in the annual email reminder.
(NV)
All providers who serve Medicaid patients are required to complete and attest to having completed cultural competency training annually. Network doctors who own their practice are required to attest that they and their staff, including all employee doctors, completed the training. VSP makes this training available on VSPOnline and sends via email annually. You may take it at any time at least once per calendar year. The training modules include:
- Cultural Competency
- Better Communication, Better Care: Provider Tools to Care for Diverse Populations
- Seniors and Persons with Disabilities
- Patients’ Rights and Responsibilities
If you completed cultural competence training from another source, you may attest to that in lieu of taking VSP-provided training. The attestation is available on VSPOnline in the Cultural Competency training section or can be accessed from the link in the annual email reminder.
(NH)
All providers who serve Medicaid patients are required to complete and attest to having completed cultural competency training annually. Network doctors who own their practice are required to attest that they and their staff, including all employee doctors, completed the training. VSP makes this training available on VSPOnline and sends via email annually. You may take it at any time at least once per calendar year. The training modules include:
- Cultural Competency
- Better Communication, Better Care: Provider Tools to Care for Diverse Populations
- Seniors and Persons with Disabilities
- Patients’ Rights and Responsibilities
If you completed cultural competence training from another source, you may attest to that in lieu of taking VSP-provided training. The attestation is available on VSPOnline in the Cultural Competency training section or can be accessed from the link in the annual email reminder.
(NY)
All providers who serve Medicaid patients are required to complete and attest to having completed cultural competency training annually. Network doctors who own their practice are required to attest that they and their staff, including all employee doctors, completed the training. VSP makes this training available on VSPOnline and sends via email annually. You may take it at any time at least once per calendar year. The training modules include:
- Cultural Competency
- Better Communication, Better Care: Provider Tools to Care for Diverse Populations
- Seniors and Persons with Disabilities
- Patients’ Rights and Responsibilities
If you completed cultural competence training from another source, you may attest to that in lieu of taking VSP-provided training. The attestation is available on VSPOnline in the Cultural Competency training section or can be accessed from the link in the annual email reminder.
(OH)
All providers who serve Medicaid patients are required to complete and attest to having completed cultural competency training annually. Network doctors who own their practice are required to attest that they and their staff, including all employee doctors, completed the training. VSP makes this training available on VSPOnline and sends via email annually. You may take it at any time at least once per calendar year. The training modules include:
- Cultural Competency
- Better Communication, Better Care: Provider Tools to Care for Diverse Populations
- Seniors and Persons with Disabilities
- Patients’ Rights and Responsibilities
If you completed cultural competence training from another source, you may attest to that in lieu of taking VSP-provided training. The attestation is available on VSPOnline in the Cultural Competency training section or can be accessed from the link in the annual email reminder.
(OR)
All providers who serve Medicaid patients are required to complete and attest to having completed cultural competency training annually. Network doctors who own their practice are required to attest that they and their staff, including all employee doctors, completed the training. VSP makes this training available on VSPOnline and sends via email annually. You may take it at any time at least once per calendar year. The training modules include:
- Cultural Competency
- Better Communication, Better Care: Provider Tools to Care for Diverse Populations
- Seniors and Persons with Disabilities
- Patients’ Rights and Responsibilities
If you completed cultural competence training from another source, you may attest to that in lieu of taking VSP-provided training. The attestation is available on VSPOnline in the Cultural Competency training section or can be accessed from the link in the annual email reminder.
(SC)
All providers who serve Medicaid patients are required to complete and attest to having completed cultural competency training annually. Network doctors who own their practice are required to attest that they and their staff, including all employee doctors, completed the training. VSP makes this training available on VSPOnline and sends via email annually. You may take it at any time at least once per calendar year. The training modules include:
- Cultural Competency
- Better Communication, Better Care: Provider Tools to Care for Diverse Populations
- Seniors and Persons with Disabilities
- Patients’ Rights and Responsibilities
If you completed cultural competence training from another source, you may attest to that in lieu of taking VSP-provided training. The attestation is available on VSPOnline in the Cultural Competency training section or can be accessed from the link in the annual email reminder.
(UT)
All providers who serve Medicaid patients are required to complete and attest to having completed cultural competency training annually. Network doctors who own their practice are required to attest that they and their staff, including all employee doctors, completed the training. VSP makes this training available on VSPOnline and sends via email annually. You may take it at any time at least once per calendar year. The training modules include:
- Cultural Competency
- Better Communication, Better Care: Provider Tools to Care for Diverse Populations
- Seniors and Persons with Disabilities
- Patients’ Rights and Responsibilities
If you completed cultural competence training from another source, you may attest to that in lieu of taking VSP-provided training. The attestation is available on VSPOnline in the Cultural Competency training section or can be accessed from the link in the annual email reminder.
(VA)
All providers who serve Medicaid patients are required to complete and attest to having completed cultural competency training annually. Network doctors who own their practice are required to attest that they and their staff, including all employee doctors, completed the training. VSP makes this training available on VSPOnline and sends via email annually. You may take it at any time at least once per calendar year. The training modules include:
- Cultural Competency
- Better Communication, Better Care: Provider Tools to Care for Diverse Populations
- Seniors and Persons with Disabilities
- Patients’ Rights and Responsibilities
If you completed cultural competence training from another source, you may attest to that in lieu of taking VSP-provided training. The attestation is available on VSPOnline in the Cultural Competency training section or can be accessed from the link in the annual email reminder.
(WA)
All providers who serve Medicaid patients are required to complete and attest to having completed cultural competency training annually. Network doctors who own their practice are required to attest that they and their staff, including all employee doctors, completed the training. VSP makes this training available on VSPOnline and sends via email annually. You may take it at any time at least once per calendar year. The training modules include:
- Cultural Competency
- Better Communication, Better Care: Provider Tools to Care for Diverse Populations
- Seniors and Persons with Disabilities
- Patients’ Rights and Responsibilities
If you completed cultural competence training from another source, you may attest to that in lieu of taking VSP-provided training. The attestation is available on VSPOnline in the Cultural Competency training section or can be accessed from the link in the annual email reminder.
(WV)
All providers who serve Medicaid patients are required to complete and attest to having completed cultural competency training annually. Network doctors who own their practice are required to attest that they and their staff, including all employee doctors, completed the training. VSP makes this training available on VSPOnline and sends via email annually. You may take it at any time at least once per calendar year. The training modules include:
- Cultural Competency
- Better Communication, Better Care: Provider Tools to Care for Diverse Populations
- Seniors and Persons with Disabilities
- Patients’ Rights and Responsibilities
If you completed cultural competence training from another source, you may attest to that in lieu of taking VSP-provided training. The attestation is available on VSPOnline in the Cultural Competency training section or can be accessed from the link in the annual email reminder.
(TX)
All providers who serve Medicaid patients are required to complete and attest to having completed cultural competency training annually. Network doctors who own their practice are required to attest that they and their staff, including all employee doctors, completed the training. VSP makes this training available on VSPOnline and sends via email annually. You may take it at any time at least once per calendar year. The training modules include:
- Cultural Competency
- Better Communication, Better Care: Provider Tools to Care for Diverse Populations
- Seniors and Persons with Disabilities
- Patients’ Rights and Responsibilities
If you completed cultural competence training from another source, you may attest to that in lieu of taking VSP-provided training. The attestation is available on VSPOnline in the Cultural Competency training section or can be accessed from the link in the annual email reminder.
VSP requires network doctors to use an appointment scheduling process and system that allows appointments to be scheduled according to patients’ stated eye care needs within the timeliness standards established for VSP members. The intent is to ensure that patients are handled consistently and scheduled for appointments in a manner that recognizes the urgency of their eye care needs.
- Patents experiencing an eye care emergency should be seen immediately or referred to an appropriate alternative medical facility.
- Make every effort to see the patient at their scheduled appointment time. Patient wait time should not exceed 30 minutes.
- The site must have (or arrange for) a telephone triage, voicemail system, and/or answering service to provide routine, after-hours, and urgent/emergency eye care instructions, whenever office staff is unavailable to answer phone calls. Patients should receive a return call from this system for follow-up within a reasonable timeframe.
- Ensure a process is in place to follow up on missed and canceled appointments. Missed and/or canceled appointments and contact attempts must be documented in the patient medical record.
VSP requires network doctors to use an appointment scheduling process and system that allows appointments to be scheduled according to patients’ stated eye care needs within the timeliness standards established for VSP members. The intent is to ensure that patients are handled consistently and scheduled for appointments in a manner that recognizes the urgency of their eye care needs.
- Patients experiencing an eye care emergency should be seen immediately or referred to an appropriate alternative medical facility.
- Make every effort to see the patient at their scheduled appointment time. Patient wait time should not exceed 30 minutes.
- The site must have (or arrange for) a telephone triage, voicemail system, and/or answering service to provide routine, after-hours, and urgent/emergency eye care instructions, whenever office staff is unavailable to answer phone calls. Patients should receive a return call from this system for follow-up within a reasonable timeframe.
- Ensure a process is in place to follow up on missed and canceled appointments. Missed and/or canceled appointments and contact attempts must be documented in the patient's medical record.
(AZ)
VSP requires network doctors to use an appointment scheduling process and system that allows appointments to be scheduled according to patients’ stated eye care needs within the timeliness standards established for VSP members. The intent is to ensure that patients are handled consistently and scheduled for appointments in a manner that recognizes the urgency of their eye care needs.
- Patients experiencing an eye care emergency should be seen immediately or referred to an appropriate alternative medical facility.
- Make every effort to see the patient at their scheduled appointment time. Patient wait time should not exceed 30 minutes.
- The site must have (or arrange for) a telephone triage, voicemail system, and/or answering service to provide routine, after-hours, and urgent/emergency eye care instructions, whenever office staff is unavailable to answer phone calls. Patients should receive a return call from this system for follow-up within a reasonable timeframe.
- Ensure a process is in place to follow up on missed and canceled appointments. Missed and/or canceled appointments and contact attempts must be documented in the patient's medical record.
(CA)
VSP requires network doctors to use an appointment scheduling process and system that allows appointments to be scheduled according to patients’ stated eye care needs within the timeliness standards established for VSP members. The intent is to ensure that patients are handled consistently and scheduled for appointments in a manner that recognizes the urgency of their eye care needs.
- Patients experiencing an eye care emergency should be seen immediately or referred to an appropriate alternative medical facility.
- Make every effort to see the patient at their scheduled appointment time. Patient wait time should not exceed 30 minutes.
- The site must have (or arrange for) a telephone triage, voicemail system, and/or answering service to provide routine, after-hours, and urgent/emergency eye care instructions, whenever office staff is unavailable to answer phone calls. Patients should receive a return call from this system for follow-up within a reasonable timeframe.
- Ensure a process is in place to follow up on missed and canceled appointments. Missed and/or canceled appointments and contact attempts must be documented in the patient's medical record.
(IL)
VSP requires network doctors to use an appointment scheduling process and system that allows appointments to be scheduled according to patients’ stated eye care needs within the timeliness standards established for VSP members. The intent is to ensure that patients are handled consistently and scheduled for appointments in a manner that recognizes the urgency of their eye care needs.
- Patients experiencing an eye care emergency should be seen immediately or referred to an appropriate alternative medical facility.
- Make every effort to see the patient at their scheduled appointment time. Patient wait time should not exceed 30 minutes.
- The site must have (or arrange for) a telephone triage, voicemail system, and/or answering service to provide routine, after-hours, and urgent/emergency eye care instructions, whenever office staff is unavailable to answer phone calls. Patients should receive a return call from this system for follow-up within a reasonable timeframe.
- Ensure a process is in place to follow up on missed and canceled appointments. Missed and/or canceled appointments and contact attempts must be documented in the patient's medical record.
(MI)
VSP requires network doctors to use an appointment scheduling process and system that allows appointments to be scheduled according to patients’ stated eye care needs within the timeliness standards established for VSP members. The intent is to ensure that patients are handled consistently and scheduled for appointments in a manner that recognizes the urgency of their eye care needs.
- Patients experiencing an eye care emergency should be seen immediately or referred to an appropriate alternative medical facility.
- Make every effort to see the patient at their scheduled appointment time. Patient wait time should not exceed 30 minutes.
- The site must have (or arrange for) a telephone triage, voicemail system, and/or answering service to provide routine, after-hours, and urgent/emergency eye care instructions, whenever office staff is unavailable to answer phone calls. Patients should receive a return call from this system for follow-up within a reasonable timeframe.
- Ensure a process is in place to follow up on missed and canceled appointments. Missed and/or canceled appointments and contact attempts must be documented in the patient's medical record.
(NV)
VSP requires network doctors to use an appointment scheduling process and system that allows appointments to be scheduled according to patients’ stated eye care needs within the timeliness standards established for VSP members. The intent is to ensure that patients are handled consistently and scheduled for appointments in a manner that recognizes the urgency of their eye care needs.
- Patients experiencing an eye care emergency should be seen immediately or referred to an appropriate alternative medical facility.
- Make every effort to see the patient at their scheduled appointment time. Patient wait time should not exceed 30 minutes.
- The site must have (or arrange for) a telephone triage, voicemail system, and/or answering service to provide routine, after-hours, and urgent/emergency eye care instructions, whenever office staff is unavailable to answer phone calls. Patients should receive a return call from this system for follow-up within a reasonable timeframe.
- Ensure a process is in place to follow up on missed and canceled appointments. Missed and/or canceled appointments and contact attempts must be documented in the patient's medical record.
(NH)
VSP requires network doctors to use an appointment scheduling process and system that allows appointments to be scheduled according to patients’ stated eye care needs within the timeliness standards established for VSP members. The intent is to ensure that patients are handled consistently and scheduled for appointments in a manner that recognizes the urgency of their eye care needs.
- Patients experiencing an eye care emergency should be seen immediately or referred to an appropriate alternative medical facility.
- Make every effort to see the patient at their scheduled appointment time. Patient wait time should not exceed 30 minutes.
- The site must have (or arrange for) a telephone triage, voicemail system, and/or answering service to provide routine, after-hours, and urgent/emergency eye care instructions, whenever office staff is unavailable to answer phone calls. Patients should receive a return call from this system for follow-up within a reasonable timeframe.
- Ensure a process is in place to follow up on missed and canceled appointments. Missed and/or canceled appointments and contact attempts must be documented in the patient's medical record.
(NY)
VSP requires network doctors to use an appointment scheduling process and system that allows appointments to be scheduled according to patients’ stated eye care needs within the timeliness standards established for VSP members. The intent is to ensure that patients are handled consistently and scheduled for appointments in a manner that recognizes the urgency of their eye care needs.
- Patients experiencing an eye care emergency should be seen immediately or referred to an appropriate alternative medical facility.
- Make every effort to see the patient at their scheduled appointment time. Patient wait time should not exceed 30 minutes.
- The site must have (or arrange for) a telephone triage, voicemail system, and/or answering service to provide routine, after-hours, and urgent/emergency eye care instructions, whenever office staff is unavailable to answer phone calls. Patients should receive a return call from this system for follow-up within a reasonable timeframe.
- Ensure a process is in place to follow up on missed and canceled appointments. Missed and/or canceled appointments and contact attempts must be documented in the patient's medical record.
(OH)
VSP requires network doctors to use an appointment scheduling process and system that allows appointments to be scheduled according to patients’ stated eye care needs within the timeliness standards established for VSP members. The intent is to ensure that patients are handled consistently and scheduled for appointments in a manner that recognizes the urgency of their eye care needs.
- Patients experiencing an eye care emergency should be seen immediately or referred to an appropriate alternative medical facility.
- Make every effort to see the patient at their scheduled appointment time. Patient wait time should not exceed 30 minutes.
- The site must have (or arrange for) a telephone triage, voicemail system, and/or answering service to provide routine, after-hours, and urgent/emergency eye care instructions, whenever office staff is unavailable to answer phone calls. Patients should receive a return call from this system for follow-up within a reasonable timeframe.
- Ensure a process is in place to follow up on missed and canceled appointments. Missed and/or canceled appointments and contact attempts must be documented in the patient's medical record.
(OR)
VSP requires network doctors to use an appointment scheduling process and system that allows appointments to be scheduled according to patients’ stated eye care needs within the timeliness standards established for VSP members. The intent is to ensure that patients are handled consistently and scheduled for appointments in a manner that recognizes the urgency of their eye care needs.
- Patients experiencing an eye care emergency should be seen immediately or referred to an appropriate alternative medical facility.
- Make every effort to see the patient at their scheduled appointment time. Patient wait time should not exceed 30 minutes.
- The site must have (or arrange for) a telephone triage, voicemail system, and/or answering service to provide routine, after-hours, and urgent/emergency eye care instructions, whenever office staff is unavailable to answer phone calls. Patients should receive a return call from this system for follow-up within a reasonable timeframe.
- Ensure a process is in place to follow up on missed and canceled appointments. Missed and/or canceled appointments and contact attempts must be documented in the patient's medical record.
(SC)
VSP requires network doctors to use an appointment scheduling process and system that allows appointments to be scheduled according to patients’ stated eye care needs within the timeliness standards established for VSP members. The intent is to ensure that patients are handled consistently and scheduled for appointments in a manner that recognizes the urgency of their eye care needs.
- Patients experiencing an eye care emergency should be seen immediately or referred to an appropriate alternative medical facility.
- Make every effort to see the patient at their scheduled appointment time. Patient wait time should not exceed 30 minutes.
- The site must have (or arrange for) a telephone triage, voicemail system, and/or answering service to provide routine, after-hours, and urgent/emergency eye care instructions, whenever office staff is unavailable to answer phone calls. Patients should receive a return call from this system for follow-up within a reasonable timeframe.
- Ensure a process is in place to follow up on missed and canceled appointments. Missed and/or canceled appointments and contact attempts must be documented in the patient's medical record.
(UT)
VSP requires network doctors to use an appointment scheduling process and system that allows appointments to be scheduled according to patients’ stated eye care needs within the timeliness standards established for VSP members. The intent is to ensure that patients are handled consistently and scheduled for appointments in a manner that recognizes the urgency of their eye care needs.
- Patients experiencing an eye care emergency should be seen immediately or referred to an appropriate alternative medical facility.
- Make every effort to see the patient at their scheduled appointment time. Patient wait time should not exceed 30 minutes.
- The site must have (or arrange for) a telephone triage, voicemail system, and/or answering service to provide routine, after-hours, and urgent/emergency eye care instructions, whenever office staff is unavailable to answer phone calls. Patients should receive a return call from this system for follow-up within a reasonable timeframe.
- Ensure a process is in place to follow up on missed and canceled appointments. Missed and/or canceled appointments and contact attempts must be documented in the patient's medical record.
(VA)
VSP requires network doctors to use an appointment scheduling process and system that allows appointments to be scheduled according to patients’ stated eye care needs within the timeliness standards established for VSP members. The intent is to ensure that patients are handled consistently and scheduled for appointments in a manner that recognizes the urgency of their eye care needs.
- Patients experiencing an eye care emergency should be seen immediately or referred to an appropriate alternative medical facility.
- Make every effort to see the patient at their scheduled appointment time. Patient wait time should not exceed 30 minutes.
- The site must have (or arrange for) a telephone triage, voicemail system, and/or answering service to provide routine, after-hours, and urgent/emergency eye care instructions, whenever office staff is unavailable to answer phone calls. Patients should receive a return call from this system for follow-up within a reasonable timeframe.
- Ensure a process is in place to follow up on missed and canceled appointments. Missed and/or canceled appointments and contact attempts must be documented in the patient's medical record.
(WA)
VSP requires network doctors to use an appointment scheduling process and system that allows appointments to be scheduled according to patients’ stated eye care needs within the timeliness standards established for VSP members. The intent is to ensure that patients are handled consistently and scheduled for appointments in a manner that recognizes the urgency of their eye care needs.
- Patients experiencing an eye care emergency should be seen immediately or referred to an appropriate alternative medical facility.
- Make every effort to see the patient at their scheduled appointment time. Patient wait time should not exceed 30 minutes.
- The site must have (or arrange for) a telephone triage, voicemail system, and/or answering service to provide routine, after-hours, and urgent/emergency eye care instructions, whenever office staff is unavailable to answer phone calls. Patients should receive a return call from this system for follow-up within a reasonable timeframe.
- Ensure a process is in place to follow up on missed and canceled appointments. Missed and/or canceled appointments and contact attempts must be documented in the patient's medical record.
(WV)
VSP requires network doctors to use an appointment scheduling process and system that allows appointments to be scheduled according to patients’ stated eye care needs within the timeliness standards established for VSP members. The intent is to ensure that patients are handled consistently and scheduled for appointments in a manner that recognizes the urgency of their eye care needs.
- Patients experiencing an eye care emergency should be seen immediately or referred to an appropriate alternative medical facility.
- Make every effort to see the patient at their scheduled appointment time. Patient wait time should not exceed 30 minutes.
- The site must have (or arrange for) a telephone triage, voicemail system, and/or answering service to provide routine, after-hours, and urgent/emergency eye care instructions, whenever office staff is unavailable to answer phone calls. Patients should receive a return call from this system for follow-up within a reasonable timeframe.
- Ensure a process is in place to follow up on missed and canceled appointments. Missed and/or canceled appointments and contact attempts must be documented in the patient's medical record.
(TX)
VSP requires network doctors to use an appointment scheduling process and system that allows appointments to be scheduled according to patients’ stated eye care needs within the timeliness standards established for VSP members. The intent is to ensure that patients are handled consistently and scheduled for appointments in a manner that recognizes the urgency of their eye care needs.
- Patients experiencing an eye care emergency should be seen immediately or referred to an appropriate alternative medical facility.
- Make every effort to see the patient at their scheduled appointment time. Patient wait time should not exceed 30 minutes.
- The site must have (or arrange for) a telephone triage, voicemail system, and/or answering service to provide routine, after-hours, and urgent/emergency eye care instructions, whenever office staff is unavailable to answer phone calls. Patients should receive a return call from this system for follow-up within a reasonable timeframe.
- Ensure a process is in place to follow up on missed and canceled appointments. Missed and/or canceled appointments and contact attempts must be documented in the patient's medical record.
VSP requires network doctors to use an appointment scheduling process and system that allows appointments to be scheduled according to patients’ stated eye care needs within the timeliness standards established for VSP members. The intent is to ensure that patients are handled consistently and scheduled for appointments in a manner that recognizes the urgency of their eye care needs.
- Patents experiencing an eye care emergency should be seen immediately or referred to an appropriate alternative medical facility.
- Make every effort to see the patient at their scheduled appointment time. Patient wait time should not exceed 30 minutes.
- The site must have (or arrange for) a telephone triage, voicemail system, and/or answering service to provide routine, after-hours, and urgent/emergency eye care instructions, whenever office staff is unavailable to answer phone calls. Patients should receive a return call from this system for follow-up within a reasonable timeframe.
- Ensure a process is in place to follow up on missed and canceled appointments. Missed and/or canceled appointments and contact attempts must be documented in the patient medical record.
(AZ)
When you contact VSP for an authorization, please provide the following information:
- Last four-digits of the member’s Social Security Number and date of birth or the entire client-assigned ID number
- Member’s Medicaid number if different from Social Security Number
- Patient’s date of birth
- Patient’s HMO name
There are several ways to obtain an authorization:
VSP’s Electronic Claim Submission System—Enter member’s Social Security Number or client-assigned ID number using eyefinity’s website and select “Check Patient Eligibility” to access eligible plans. You may wish to print the plan information to discuss plan coverages with your patients.
Customer Service—Call VSP at 800.615.1883. You may select “1” to contact our automated Interactive Voice Response (IVR) system, or you may speak with a Customer Service Representative who will verify the patient’s current eligibility, provide plan information, and issue an authorization.
(CA)
When you contact VSP for an authorization, please provide the following information:
- Last four-digits of the member’s Social Security Number and date of birth or the entire client-assigned ID number
- Member’s Medicaid number if different from Social Security Number
- Patient’s date of birth
- Patient’s HMO name
There are several ways to obtain an authorization:
VSP’s Electronic Claim Submission System—Enter member’s Social Security Number or client-assigned ID number using eyefinity’s website and select “Check Patient Eligibility” to access eligible plans. You may wish to print the plan information to discuss plan coverages with your patients.
Customer Service—Call VSP at 800.615.1883. You may select “1” to contact our automated Interactive Voice Response (IVR) system, or you may speak with a Customer Service Representative who will verify the patient’s current eligibility, provide plan information, and issue an authorization.
(IL)
When you contact VSP for an authorization, please provide the following information:
- Last four-digits of the member’s Social Security Number and date of birth or the entire client-assigned ID number
- Member’s Medicaid number if different from Social Security Number
- Patient’s date of birth
- Patient’s HMO name
There are several ways to obtain an authorization:
VSP’s Electronic Claim Submission System—Enter member’s Social Security Number or client-assigned ID number using eyefinity’s website and select “Check Patient Eligibility” to access eligible plans. You may wish to print the plan information to discuss plan coverages with your patients.
Customer Service—Call VSP at 800.615.1883. You may select “1” to contact our automated Interactive Voice Response (IVR) system, or you may speak with a Customer Service Representative who will verify the patient’s current eligibility, provide plan information, and issue an authorization.
(MI)
When you contact VSP for an authorization, please provide the following information:
- Last four-digits of the member’s Social Security Number and date of birth or the entire client-assigned ID number
- Member’s Medicaid number if different from Social Security Number
- Patient’s date of birth
- Patient’s HMO name
There are several ways to obtain an authorization:
VSP’s Electronic Claim Submission System—Enter member’s Social Security Number or client-assigned ID number using eyefinity’s website and select “Check Patient Eligibility” to access eligible plans. You may wish to print the plan information to discuss plan coverages with your patients.
Customer Service—Call VSP at 800.615.1883. You may select “1” to contact our automated Interactive Voice Response (IVR) system, or you may speak with a Customer Service Representative who will verify the patient’s current eligibility, provide plan information, and issue an authorization.
(NV)
When you contact VSP for an authorization, please provide the following information:
- Last four-digits of the member’s Social Security Number and date of birth or the entire client-assigned ID number
- Member’s Medicaid number if different from Social Security Number
- Patient’s date of birth
- Patient’s HMO name
There are several ways to obtain an authorization:
VSP’s Electronic Claim Submission System—Enter member’s Social Security Number or client-assigned ID number using eyefinity’s website and select “Check Patient Eligibility” to access eligible plans. You may wish to print the plan information to discuss plan coverages with your patients.
Customer Service—Call VSP at 800.615.1883. You may select “1” to contact our automated Interactive Voice Response (IVR) system, or you may speak with a Customer Service Representative who will verify the patient’s current eligibility, provide plan information, and issue an authorization.
(NH)
When you contact VSP for an authorization, please provide the following information:
- Last four-digits of the member’s Social Security Number and date of birth or the entire client-assigned ID number
- Member’s Medicaid number if different from Social Security Number
- Patient’s date of birth
- Patient’s HMO name
There are several ways to obtain an authorization:
VSP’s Electronic Claim Submission System—Enter member’s Social Security Number or client-assigned ID number using eyefinity’s website and select “Check Patient Eligibility” to access eligible plans. You may wish to print the plan information to discuss plan coverages with your patients.
Customer Service—Call VSP at 800.615.1883. You may select “1” to contact our automated Interactive Voice Response (IVR) system, or you may speak with a Customer Service Representative who will verify the patient’s current eligibility, provide plan information, and issue an authorization.
(NY)
When you contact VSP for an authorization, please provide the following information:
- Last four-digits of the member’s Social Security Number and date of birth or the entire client-assigned ID number
- Member’s Medicaid number if different from Social Security Number
- Patient’s date of birth
- Patient’s HMO name
There are several ways to obtain an authorization:
VSP’s Electronic Claim Submission System—Enter member’s Social Security Number or client-assigned ID number using eyefinity’s website and select “Check Patient Eligibility” to access eligible plans. You may wish to print the plan information to discuss plan coverages with your patients.
Customer Service—Call VSP at 800.615.1883. You may select “1” to contact our automated Interactive Voice Response (IVR) system, or you may speak with a Customer Service Representative who will verify the patient’s current eligibility, provide plan information, and issue an authorization.
(OH)
When you contact VSP for an authorization, please provide the following information:
- Last four-digits of the member’s Social Security Number and date of birth or the entire client-assigned ID number
- Member’s Medicaid number if different from Social Security Number
- Patient’s date of birth
- Patient’s HMO name
There are several ways to obtain an authorization:
VSP’s Electronic Claim Submission System—Enter member’s Social Security Number or client-assigned ID number using eyefinity’s website and select “Check Patient Eligibility” to access eligible plans. You may wish to print the plan information to discuss plan coverages with your patients.
Customer Service—Call VSP at 800.615.1883. You may select “1” to contact our automated Interactive Voice Response (IVR) system, or you may speak with a Customer Service Representative who will verify the patient’s current eligibility, provide plan information, and issue an authorization.
(OR)
When you contact VSP for an authorization, please provide the following information:
- Last four-digits of the member’s Social Security Number and date of birth or the entire client-assigned ID number
- Member’s Medicaid number if different from Social Security Number
- Patient’s date of birth
- Patient’s HMO name
There are several ways to obtain an authorization:
VSP’s Electronic Claim Submission System—Enter member’s Social Security Number or client-assigned ID number using eyefinity’s website and select “Check Patient Eligibility” to access eligible plans. You may wish to print the plan information to discuss plan coverages with your patients.
Customer Service—Call VSP at 800.615.1883. You may select “1” to contact our automated Interactive Voice Response (IVR) system, or you may speak with a Customer Service Representative who will verify the patient’s current eligibility, provide plan information, and issue an authorization.
(SC)
When you contact VSP for an authorization, please provide the following information:
- Last four-digits of the member’s Social Security Number and date of birth or the entire client-assigned ID number
- Member’s Medicaid number if different from Social Security Number
- Patient’s date of birth
- Patient’s HMO name
There are several ways to obtain an authorization:
VSP’s Electronic Claim Submission System—Enter member’s Social Security Number or client-assigned ID number using eyefinity’s website and select “Check Patient Eligibility” to access eligible plans. You may wish to print the plan information to discuss plan coverages with your patients.
Customer Service—Call VSP at 800.615.1883. You may select “1” to contact our automated Interactive Voice Response (IVR) system, or you may speak with a Customer Service Representative who will verify the patient’s current eligibility, provide plan information, and issue an authorization.
(UT)
When you contact VSP for an authorization, please provide the following information:
- Last four-digits of the member’s Social Security Number and date of birth or the entire client-assigned ID number
- Member’s Medicaid number if different from Social Security Number
- Patient’s date of birth
- Patient’s HMO name
There are several ways to obtain an authorization:
VSP’s Electronic Claim Submission System—Enter member’s Social Security Number or client-assigned ID number using eyefinity’s website and select “Check Patient Eligibility” to access eligible plans. You may wish to print the plan information to discuss plan coverages with your patients.
Customer Service—Call VSP at 800.615.1883. You may select “1” to contact our automated Interactive Voice Response (IVR) system, or you may speak with a Customer Service Representative who will verify the patient’s current eligibility, provide plan information, and issue an authorization.
(VA)
When you contact VSP for an authorization, please provide the following information:
- Last four-digits of the member’s Social Security Number and date of birth or the entire client-assigned ID number
- Member’s Medicaid number if different from Social Security Number
- Patient’s date of birth
- Patient’s HMO name
There are several ways to obtain an authorization:
VSP’s Electronic Claim Submission System—Enter member’s Social Security Number or client-assigned ID number using eyefinity’s website and select “Check Patient Eligibility” to access eligible plans. You may wish to print the plan information to discuss plan coverages with your patients.
Customer Service—Call VSP at 800.615.1883. You may select “1” to contact our automated Interactive Voice Response (IVR) system, or you may speak with a Customer Service Representative who will verify the patient’s current eligibility, provide plan information, and issue an authorization.
(WA)
When you contact VSP for an authorization, please provide the following information:
- Last four-digits of the member’s Social Security Number and date of birth or the entire client-assigned ID number
- Member’s Medicaid number if different from Social Security Number
- Patient’s date of birth
- Patient’s HMO name
There are several ways to obtain an authorization:
VSP’s Electronic Claim Submission System—Enter member’s Social Security Number or client-assigned ID number using eyefinity’s website and select “Check Patient Eligibility” to access eligible plans. You may wish to print the plan information to discuss plan coverages with your patients.
Customer Service—Call VSP at 800.615.1883. You may select “1” to contact our automated Interactive Voice Response (IVR) system, or you may speak with a Customer Service Representative who will verify the patient’s current eligibility, provide plan information, and issue an authorization.
(WV)
When you contact VSP for an authorization, please provide the following information:
- Last four-digits of the member’s Social Security Number and date of birth or the entire client-assigned ID number
- Member’s Medicaid number if different from Social Security Number
- Patient’s date of birth
- Patient’s HMO name
There are several ways to obtain an authorization:
VSP’s Electronic Claim Submission System—Enter member’s Social Security Number or client-assigned ID number using eyefinity’s website and select “Check Patient Eligibility” to access eligible plans. You may wish to print the plan information to discuss plan coverages with your patients.
Customer Service—Call VSP at 800.615.1883. You may select “1” to contact our automated Interactive Voice Response (IVR) system, or you may speak with a Customer Service Representative who will verify the patient’s current eligibility, provide plan information, and issue an authorization.
(TX)
When you contact VSP for an authorization, please provide the following information:
- Last four-digits of the member’s Social Security Number and date of birth or the entire client-assigned ID number
- Member’s Medicaid number if different from Social Security Number
- Patient’s date of birth
- Patient’s HMO name
There are several ways to obtain an authorization:
VSP’s Electronic Claim Submission System—Enter member’s Social Security Number or client-assigned ID number using eyefinity’s website and select “Check Patient Eligibility” to access eligible plans. You may wish to print the plan information to discuss plan coverages with your patients.
Customer Service—Call VSP at 800.615.1883. You may select “1” to contact our automated Interactive Voice Response (IVR) system, or you may speak with a Customer Service Representative who will verify the patient’s current eligibility, provide plan information, and issue an authorization.
VSP requires network doctors to use an appointment scheduling process and system that allows appointments to be scheduled according to patients’ stated eye care needs within the timeliness standards established for VSP members. The intent is to ensure that patients are handled consistently and scheduled for appointments in a manner that recognizes the urgency of their eye care needs.
- Patents experiencing an eye care emergency should be seen immediately or referred to an appropriate alternative medical facility.
- Make every effort to see the patient at their scheduled appointment time. Patient wait time should not exceed 30 minutes.
- The site must have (or arrange for) a telephone triage, voicemail system, and/or answering service to provide routine, after-hours, and urgent/emergency eye care instructions, whenever office staff is unavailable to answer phone calls. Patients should receive a return call from this system for follow-up within a reasonable timeframe.
- Ensure a process is in place to follow up on missed and canceled appointments. Missed and/or canceled appointments and contact attempts must be documented in the patient medical record.
Note:
When the member’s eligibility has been verified, VSP will provide an authorization number that is effective through the last day of the current month.
Note:
When the member’s eligibility has been verified, VSP will provide an authorization number that is effective through the last day of the current month.
Note:
When the member’s eligibility has been verified, VSP will provide an authorization number that is effective through the last day of the current month.
Note:
When the member’s eligibility has been verified, VSP will provide an authorization number that is effective through the last day of the current month.
Note:
When the member’s eligibility has been verified, VSP will provide an authorization number that is effective through the last day of the current month.
Note:
When the member’s eligibility has been verified, VSP will provide an authorization number that is effective through the last day of the current month.
Note:
When the member’s eligibility has been verified, VSP will provide an authorization number that is effective through the last day of the current month.
Note:
When the member’s eligibility has been verified, VSP will provide an authorization number that is effective through the last day of the current month.
Note:
When the member’s eligibility has been verified, VSP will provide an authorization number that is effective through the last day of the current month.
Note:
When the member’s eligibility has been verified, VSP will provide an authorization number that is effective through the last day of the current month.
Note:
When the member’s eligibility has been verified, VSP will provide an authorization number that is effective through the last day of the current month.
Note:
When the member’s eligibility has been verified, VSP will provide an authorization number that is effective through the last day of the current month.
Note:
When the member’s eligibility has been verified, VSP will provide an authorization number that is effective through the last day of the current month.
(WV)
If the Medicaid patient has vision care coverage through any carrier other than VSP or another VSP plan, you must bill that carrier or the other VSP plan first. The VSP Medicaid Plan should be billed as secondary, where appropriate. For electronic claim submission, be sure to provide the patient’s responsibility for exam and refraction separately.
Note:
When the member’s eligibility has been verified, VSP will provide an authorization number that is effective through the last day of the current month.
(AZ)
If the Medicaid patient has vision care coverage through any carrier other than VSP or another VSP plan, you must bill that carrier or the other VSP plan first. The VSP Medicaid Plan should be billed as secondary, where appropriate. For electronic claim submission, be sure to provide the patient’s responsibility for exam and refraction separately.
(CA)
If the Medicaid patient has vision care coverage through any carrier other than VSP or another VSP plan, you must bill that carrier or the other VSP plan first. The VSP Medicaid Plan should be billed as secondary, where appropriate. For electronic claim submission, be sure to provide the patient’s responsibility for exam and refraction separately.
(IL)
If the Medicaid patient has vision care coverage through any carrier other than VSP or another VSP plan, you must bill that carrier or the other VSP plan first. The VSP Medicaid Plan should be billed as secondary, where appropriate. For electronic claim submission, be sure to provide the patient’s responsibility for exam and refraction separately.
(MI)
If the Medicaid patient has vision care coverage through any carrier other than VSP or another VSP plan, you must bill that carrier or the other VSP plan first. The VSP Medicaid Plan should be billed as secondary, where appropriate. For electronic claim submission, be sure to provide the patient’s responsibility for exam and refraction separately.
(NV)
If the Medicaid patient has vision care coverage through any carrier other than VSP or another VSP plan, you must bill that carrier or the other VSP plan first. The VSP Medicaid Plan should be billed as secondary, where appropriate. For electronic claim submission, be sure to provide the patient’s responsibility for exam and refraction separately.
(NH)
If the Medicaid patient has vision care coverage through any carrier other than VSP or another VSP plan, you must bill that carrier or the other VSP plan first. The VSP Medicaid Plan should be billed as secondary, where appropriate. For electronic claim submission, be sure to provide the patient’s responsibility for exam and refraction separately.
(NY)
If the Medicaid patient has vision care coverage through any carrier other than VSP or another VSP plan, you must bill that carrier or the other VSP plan first. The VSP Medicaid Plan should be billed as secondary, where appropriate. For electronic claim submission, be sure to provide the patient’s responsibility for exam and refraction separately.
(OH)
If the Medicaid patient has vision care coverage through any carrier other than VSP or another VSP plan, you must bill that carrier or the other VSP plan first. The VSP Medicaid Plan should be billed as secondary, where appropriate. For electronic claim submission, be sure to provide the patient’s responsibility for exam and refraction separately.
(OR)
If the Medicaid patient has vision care coverage through any carrier other than VSP or another VSP plan, you must bill that carrier or the other VSP plan first. The VSP Medicaid Plan should be billed as secondary, where appropriate. For electronic claim submission, be sure to provide the patient’s responsibility for exam and refraction separately.
(SC)
If the Medicaid patient has vision care coverage through any carrier other than VSP or another VSP plan, you must bill that carrier or the other VSP plan first. The VSP Medicaid Plan should be billed as secondary, where appropriate. For electronic claim submission, be sure to provide the patient’s responsibility for exam and refraction separately.
(UT)
If the Medicaid patient has vision care coverage through any carrier other than VSP or another VSP plan, you must bill that carrier or the other VSP plan first. The VSP Medicaid Plan should be billed as secondary, where appropriate. For electronic claim submission, be sure to provide the patient’s responsibility for exam and refraction separately.
(VA)
If the Medicaid patient has vision care coverage through any carrier other than VSP or another VSP plan, you must bill that carrier or the other VSP plan first. The VSP Medicaid Plan should be billed as secondary, where appropriate. For electronic claim submission, be sure to provide the patient’s responsibility for exam and refraction separately.
(WA)
If the Medicaid patient has vision care coverage through any carrier other than VSP or another VSP plan, you must bill that carrier or the other VSP plan first. The VSP Medicaid Plan should be billed as secondary, where appropriate. For electronic claim submission, be sure to provide the patient’s responsibility for exam and refraction separately.
(TX)
If the Medicaid patient has vision care coverage through any carrier other than VSP or another VSP plan, you must bill that carrier or the other VSP plan first. The VSP Medicaid Plan should be billed as secondary, where appropriate. For electronic claim submission, be sure to provide the patient’s responsibility for exam and refraction separately.
Exam Coverage
This material is confidential, intended for the use of VSP Vision doctors only. The contents may not be shared with any unauthorized person. This manual is the property of VSP Vsion.
This material is confidential, intended for the use of VSP Vision doctors only. The contents may not be shared with any unauthorized person. This manual is the property of VSP Vision.
Exam Coverage (AZ)
Routine eye exam coverage and timeframes are established by State regulations.
In addition to coverage for routine vision care services, Medicaid members are typically covered for services under Essential Medical Eye Care or Integrated Primary EyeCare Program. Any exceptions to this coverage are described in the Client Detail pages and/or the Fee Schedule.
For Telemedicine information refer to: Telemedicine.
Exam Coverage (CA)
Routine eye exam coverage and timeframes are established by State regulations.
In addition to coverage for routine vision care services, Medicaid members are typically covered for services under Essential Medical Eye Care or Integrated Primary EyeCare Program. Any exceptions to this coverage are described in the Client Detail pages and/or the Fee Schedule.
For Telemedicine information refer to: Telemedicine.
Exam Coverage (IL)
Routine eye exam coverage and timeframes are established by State regulations.
In addition to coverage for routine vision care services, Medicaid members are typically covered for services under Essential Medical Eye Care or Integrated Primary EyeCare Program. Any exceptions to this coverage are described in the Client Detail pages and/or the Fee Schedule.
For Telemedicine information refer to: Telemedicine.
Exam Coverage (MI)
Routine eye exam coverage and timeframes are established by State regulations.
In addition to coverage for routine vision care services, Medicaid members are typically covered for services under Essential Medical Eye Care or Integrated Primary EyeCare Program. Any exceptions to this coverage are described in the Client Detail pages and/or the Fee Schedule.
For Telemedicine information refer to: Telemedicine.
Exam Coverage (NV)
Routine eye exam coverage and timeframes are established by State regulations.
In addition to coverage for routine vision care services, Medicaid members are typically covered for services under Essential Medical Eye Care or Integrated Primary EyeCare Program. Any exceptions to this coverage are described in the Client Detail pages and/or the Fee Schedule.
For Telemedicine information refer to: Telemedicine.
Exam Coverage (NH)
Routine eye exam coverage and timeframes are established by State regulations.
In addition to coverage for routine vision care services, Medicaid members are typically covered for services under Essential Medical Eye Care or Integrated Primary EyeCare Program. Any exceptions to this coverage are described in the Client Detail pages and/or the Fee Schedule.
For Telemedicine information refer to: Telemedicine.
Exam Coverage (NY)
Routine eye exam coverage and timeframes are established by State regulations.
In addition to coverage for routine vision care services, Medicaid members are typically covered for services under Essential Medical Eye Care or Integrated Primary EyeCare Program. Any exceptions to this coverage are described in the Client Detail pages and/or the Fee Schedule.
For Telemedicine information refer to: Telemedicine.
Exam Coverage (OH)
Routine eye exam coverage and timeframes are established by State regulations.
In addition to coverage for routine vision care services, Medicaid members are typically covered for services under Essential Medical Eye Care or Integrated Primary EyeCare Program. Any exceptions to this coverage are described in the Client Detail pages and/or the Fee Schedule.
For Telemedicine information refer to: Telemedicine.
Exam Coverage (OR)
Routine eye exam coverage and timeframes are established by State regulations.
In addition to coverage for routine vision care services, Medicaid members are typically covered for services under Essential Medical Eye Care or Integrated Primary EyeCare Program. Any exceptions to this coverage are described in the Client Detail pages and/or the Fee Schedule.
For Telemedicine information refer to: Telemedicine.
Exam Coverage (SC)
Routine eye exam coverage and timeframes are established by State regulations.
In addition to coverage for routine vision care services, Medicaid members are typically covered for services under Essential Medical Eye Care or Integrated Primary EyeCare Program. Any exceptions to this coverage are described in the Client Detail pages and/or the Fee Schedule.
For Telemedicine information refer to: Telemedicine.
Exam Coverage (UT)
Routine eye exam coverage and timeframes are established by State regulations.
In addition to coverage for routine vision care services, Medicaid members are typically covered for services under Essential Medical Eye Care or Integrated Primary EyeCare Program. Any exceptions to this coverage are described in the Client Detail pages and/or the Fee Schedule.
For Telemedicine information refer to: Telemedicine.
Exam Coverage (VA)
Routine eye exam coverage and timeframes are established by State regulations.
In addition to coverage for routine vision care services, Medicaid members are typically covered for services under Essential Medical Eye Care or Integrated Primary EyeCare Program. Any exceptions to this coverage are described in the Client Detail pages and/or the Fee Schedule.
For Telemedicine information refer to: Telemedicine.
Exam Coverage (WA)
Routine eye exam coverage and timeframes are established by State regulations.
In addition to coverage for routine vision care services, Medicaid members are typically covered for services under Essential Medical Eye Care or Integrated Primary EyeCare Program. Any exceptions to this coverage are described in the Client Detail pages and/or the Fee Schedule.
For Telemedicine information refer to: Telemedicine.
Exam Coverage (WV)
Routine eye exam coverage and timeframes are established by State regulations.
In addition to coverage for routine vision care services, Medicaid members are typically covered for services under Essential Medical Eye Care or Integrated Primary EyeCare Program. Any exceptions to this coverage are described in the Client Detail pages and/or the Fee Schedule.
For Telemedicine information refer to: Telemedicine.
(AZ)
Follow all referral protocols set forth by your patient’s health plan for any services beyond the scope of the patient’s VSP plan. Typically, an HMO requires that patient referrals be coordinated by the primary care physician (PCP). However, a PPO usually allows patients to receive care from any medical provider without a PCP referral. Check Client Detail pages for any specific instructions or exceptions.
(CA)
Follow all referral protocols set forth by your patient’s health plan for any services beyond the scope of the patient’s VSP plan. Typically, an HMO requires that patient referrals be coordinated by the primary care physician (PCP). However, a PPO usually allows patients to receive care from any medical provider without a PCP referral. Check Client Detail pages for any specific instructions or exceptions.
(IL)
Follow all referral protocols set forth by your patient’s health plan for any services beyond the scope of the patient’s VSP plan. Typically, an HMO requires that patient referrals be coordinated by the primary care physician (PCP). However, a PPO usually allows patients to receive care from any medical provider without a PCP referral. Check Client Detail pages for any specific instructions or exceptions.
(MI)
Follow all referral protocols set forth by your patient’s health plan for any services beyond the scope of the patient’s VSP plan. Typically, an HMO requires that patient referrals be coordinated by the primary care physician (PCP). However, a PPO usually allows patients to receive care from any medical provider without a PCP referral. Check Client Detail pages for any specific instructions or exceptions.
(NV)
Follow all referral protocols set forth by your patient’s health plan for any services beyond the scope of the patient’s VSP plan. Typically, an HMO requires that patient referrals be coordinated by the primary care physician (PCP). However, a PPO usually allows patients to receive care from any medical provider without a PCP referral. Check Client Detail pages for any specific instructions or exceptions.
(NH)
Follow all referral protocols set forth by your patient’s health plan for any services beyond the scope of the patient’s VSP plan. Typically, an HMO requires that patient referrals be coordinated by the primary care physician (PCP). However, a PPO usually allows patients to receive care from any medical provider without a PCP referral. Check Client Detail pages for any specific instructions or exceptions.
(NY)
Follow all referral protocols set forth by your patient’s health plan for any services beyond the scope of the patient’s VSP plan. Typically, an HMO requires that patient referrals be coordinated by the primary care physician (PCP). However, a PPO usually allows patients to receive care from any medical provider without a PCP referral. Check Client Detail pages for any specific instructions or exceptions.
(OH)
Follow all referral protocols set forth by your patient’s health plan for any services beyond the scope of the patient’s VSP plan. Typically, an HMO requires that patient referrals be coordinated by the primary care physician (PCP). However, a PPO usually allows patients to receive care from any medical provider without a PCP referral. Check Client Detail pages for any specific instructions or exceptions.
(OR)
Follow all referral protocols set forth by your patient’s health plan for any services beyond the scope of the patient’s VSP plan. Typically, an HMO requires that patient referrals be coordinated by the primary care physician (PCP). However, a PPO usually allows patients to receive care from any medical provider without a PCP referral. Check Client Detail pages for any specific instructions or exceptions.
(SC)
Follow all referral protocols set forth by your patient’s health plan for any services beyond the scope of the patient’s VSP plan. Typically, an HMO requires that patient referrals be coordinated by the primary care physician (PCP). However, a PPO usually allows patients to receive care from any medical provider without a PCP referral. Check Client Detail pages for any specific instructions or exceptions.
(UT)
Follow all referral protocols set forth by your patient’s health plan for any services beyond the scope of the patient’s VSP plan. Typically, an HMO requires that patient referrals be coordinated by the primary care physician (PCP). However, a PPO usually allows patients to receive care from any medical provider without a PCP referral. Check Client Detail pages for any specific instructions or exceptions.
(VA)
Follow all referral protocols set forth by your patient’s health plan for any services beyond the scope of the patient’s VSP plan. Typically, an HMO requires that patient referrals be coordinated by the primary care physician (PCP). However, a PPO usually allows patients to receive care from any medical provider without a PCP referral. Check Client Detail pages for any specific instructions or exceptions.
(WA)
Follow all referral protocols set forth by your patient’s health plan for any services beyond the scope of the patient’s VSP plan. Typically, an HMO requires that patient referrals be coordinated by the primary care physician (PCP). However, a PPO usually allows patients to receive care from any medical provider without a PCP referral. Check Client Detail pages for any specific instructions or exceptions.
(WV)
Follow all referral protocols set forth by your patient’s health plan for any services beyond the scope of the patient’s VSP plan. Typically, an HMO requires that patient referrals be coordinated by the primary care physician (PCP). However, a PPO usually allows patients to receive care from any medical provider without a PCP referral. Check Client Detail pages for any specific instructions or exceptions.
(TX)
Routine eye exam coverage and timeframes are established by State regulations. In addition to coverage for routine vision care services, Medicaid members are typically covered for services under Essential Medical Eye Care or Integrated Primary EyeCare Program. Any exceptions to this coverage are described in the Client Detail pages and/or the Fee Schedule. For Telemedicine information refer to: Telemedicine.
(AZ)
The Healthcare Effectiveness Data and Information Set (HEDIS®) is one of healthcare’s most widely used performance improvement tools. The National Committee for Quality Assurance (NCQA) collects HEDIS data from health plans and other healthcare organizations to create annual health outcome surveys. Health plans use HEDIS data to measure performance and identify opportunities for improvement.
HEDIS includes more than 90 measures across multiple domains of care. These measures relate to public health issues, including (and not limited to) asthma medication use, blood pressure control, cancer screening, diabetes care, heart disease, and smoking and tobacco use cessation.
Eye Exam for Patients With Diabetes (EED) – Effectiveness of Care HEDIS Measure
Eye Exam for Patients With Diabetes (EED) is a specific HEDIS measure that requires health plans offering commercial, Medicaid, and Medicare plans to report the percentage of members with diabetes who had a dilated or retinal eye exam.
Measurement Definition:
Patients ages 18–75 with diabetes (Type 1 or Type 2) who received screening or monitoring for diabetic retinal eye disease:
- Retinal or dilated eye exam by an eye care professional in the measurement year or,
- A negative retinal or dilated eye exam by an eye care professional in the year prior to the measurement year.
- Note: Fundus photography with interpretation and report and certain types of retinal imaging (CPT® codes 92227, 92228, 92250, 92260, and 92314) covered by Essential Medical Eye Care may also meet the performance measurement.
(CA)
The Healthcare Effectiveness Data and Information Set (HEDIS®) is one of healthcare’s most widely used performance improvement tools. The National Committee for Quality Assurance (NCQA) collects HEDIS data from health plans and other healthcare organizations to create annual health outcome surveys. Health plans use HEDIS data to measure performance and identify opportunities for improvement.
HEDIS includes more than 90 measures across multiple domains of care. These measures relate to public health issues, including (and not limited to) asthma medication use, blood pressure control, cancer screening, diabetes care, heart disease, and smoking and tobacco use cessation.
Eye Exam for Patients With Diabetes (EED) – Effectiveness of Care HEDIS Measure
Eye Exam for Patients With Diabetes (EED) is a specific HEDIS measure that requires health plans offering commercial, Medicaid, and Medicare plans to report the percentage of members with diabetes who had a dilated or retinal eye exam.
Measurement Definition:
Patients ages 18–75 with diabetes (Type 1 or Type 2) who received screening or monitoring for diabetic retinal eye disease:
- Retinal or dilated eye exam by an eye care professional in the measurement year or,
- A negative retinal or dilated eye exam by an eye care professional in the year prior to the measurement year.
- Note: Fundus photography with interpretation and report and certain types of retinal imaging (CPT® codes 92227, 92228, 92250, 92260, and 92314) covered by Essential Medical Eye Care may also meet the performance measurement.
(IL)
The Healthcare Effectiveness Data and Information Set (HEDIS®) is one of healthcare’s most widely used performance improvement tools. The National Committee for Quality Assurance (NCQA) collects HEDIS data from health plans and other healthcare organizations to create annual health outcome surveys. Health plans use HEDIS data to measure performance and identify opportunities for improvement.
HEDIS includes more than 90 measures across multiple domains of care. These measures relate to public health issues, including (and not limited to) asthma medication use, blood pressure control, cancer screening, diabetes care, heart disease, and smoking and tobacco use cessation.
Eye Exam for Patients With Diabetes (EED) – Effectiveness of Care HEDIS Measure
Eye Exam for Patients With Diabetes (EED) is a specific HEDIS measure that requires health plans offering commercial, Medicaid, and Medicare plans to report the percentage of members with diabetes who had a dilated or retinal eye exam.
Measurement Definition:
Patients ages 18–75 with diabetes (Type 1 or Type 2) who received screening or monitoring for diabetic retinal eye disease:
- Retinal or dilated eye exam by an eye care professional in the measurement year or,
- A negative retinal or dilated eye exam by an eye care professional in the year prior to the measurement year.
- Note: Fundus photography with interpretation and report and certain types of retinal imaging (CPT® codes 92227, 92228, 92250, 92260, and 92314) covered by Essential Medical Eye Care may also meet the performance measurement.
(MI)
The Healthcare Effectiveness Data and Information Set (HEDIS®) is one of healthcare’s most widely used performance improvement tools. The National Committee for Quality Assurance (NCQA) collects HEDIS data from health plans and other healthcare organizations to create annual health outcome surveys. Health plans use HEDIS data to measure performance and identify opportunities for improvement.
HEDIS includes more than 90 measures across multiple domains of care. These measures relate to public health issues, including (and not limited to) asthma medication use, blood pressure control, cancer screening, diabetes care, heart disease, and smoking and tobacco use cessation.
Eye Exam for Patients With Diabetes (EED) – Effectiveness of Care HEDIS Measure
Eye Exam for Patients With Diabetes (EED) is a specific HEDIS measure that requires health plans offering commercial, Medicaid, and Medicare plans to report the percentage of members with diabetes who had a dilated or retinal eye exam.
Measurement Definition:
Patients ages 18–75 with diabetes (Type 1 or Type 2) who received screening or monitoring for diabetic retinal eye disease:
- Retinal or dilated eye exam by an eye care professional in the measurement year or,
- A negative retinal or dilated eye exam by an eye care professional in the year prior to the measurement year.
- Note: Fundus photography with interpretation and report and certain types of retinal imaging (CPT® codes 92227, 92228, 92250, 92260, and 92314) covered by Essential Medical Eye Care may also meet the performance measurement.
(NV)
The Healthcare Effectiveness Data and Information Set (HEDIS®) is one of healthcare’s most widely used performance improvement tools. The National Committee for Quality Assurance (NCQA) collects HEDIS data from health plans and other healthcare organizations to create annual health outcome surveys. Health plans use HEDIS data to measure performance and identify opportunities for improvement.
HEDIS includes more than 90 measures across multiple domains of care. These measures relate to public health issues, including (and not limited to) asthma medication use, blood pressure control, cancer screening, diabetes care, heart disease, and smoking and tobacco use cessation.
Eye Exam for Patients With Diabetes (EED) – Effectiveness of Care HEDIS Measure
Eye Exam for Patients With Diabetes (EED) is a specific HEDIS measure that requires health plans offering commercial, Medicaid, and Medicare plans to report the percentage of members with diabetes who had a dilated or retinal eye exam.
Measurement Definition:
Patients ages 18–75 with diabetes (Type 1 or Type 2) who received screening or monitoring for diabetic retinal eye disease:
- Retinal or dilated eye exam by an eye care professional in the measurement year or,
- A negative retinal or dilated eye exam by an eye care professional in the year prior to the measurement year.
- Note: Fundus photography with interpretation and report and certain types of retinal imaging (CPT® codes 92227, 92228, 92250, 92260, and 92314) covered by Essential Medical Eye Care may also meet the performance measurement.
(NH)
The Healthcare Effectiveness Data and Information Set (HEDIS®) is one of healthcare’s most widely used performance improvement tools. The National Committee for Quality Assurance (NCQA) collects HEDIS data from health plans and other healthcare organizations to create annual health outcome surveys. Health plans use HEDIS data to measure performance and identify opportunities for improvement.
HEDIS includes more than 90 measures across multiple domains of care. These measures relate to public health issues, including (and not limited to) asthma medication use, blood pressure control, cancer screening, diabetes care, heart disease, and smoking and tobacco use cessation.
Eye Exam for Patients With Diabetes (EED) – Effectiveness of Care HEDIS Measure
Eye Exam for Patients With Diabetes (EED) is a specific HEDIS measure that requires health plans offering commercial, Medicaid, and Medicare plans to report the percentage of members with diabetes who had a dilated or retinal eye exam.
Measurement Definition:
Patients ages 18–75 with diabetes (Type 1 or Type 2) who received screening or monitoring for diabetic retinal eye disease:
- Retinal or dilated eye exam by an eye care professional in the measurement year or,
- A negative retinal or dilated eye exam by an eye care professional in the year prior to the measurement year.
- Note: Fundus photography with interpretation and report and certain types of retinal imaging (CPT® codes 92227, 92228, 92250, 92260, and 92314) covered by Essential Medical Eye Care may also meet the performance measurement.
(NY)
The Healthcare Effectiveness Data and Information Set (HEDIS®) is one of healthcare’s most widely used performance improvement tools. The National Committee for Quality Assurance (NCQA) collects HEDIS data from health plans and other healthcare organizations to create annual health outcome surveys. Health plans use HEDIS data to measure performance and identify opportunities for improvement.
HEDIS includes more than 90 measures across multiple domains of care. These measures relate to public health issues, including (and not limited to) asthma medication use, blood pressure control, cancer screening, diabetes care, heart disease, and smoking and tobacco use cessation.
Eye Exam for Patients With Diabetes (EED) – Effectiveness of Care HEDIS Measure
Eye Exam for Patients With Diabetes (EED) is a specific HEDIS measure that requires health plans offering commercial, Medicaid, and Medicare plans to report the percentage of members with diabetes who had a dilated or retinal eye exam.
Measurement Definition:
Patients ages 18–75 with diabetes (Type 1 or Type 2) who received screening or monitoring for diabetic retinal eye disease:
- Retinal or dilated eye exam by an eye care professional in the measurement year or,
- A negative retinal or dilated eye exam by an eye care professional in the year prior to the measurement year.
- Note: Fundus photography with interpretation and report and certain types of retinal imaging (CPT® codes 92227, 92228, 92250, 92260, and 92314) covered by Essential Medical Eye Care may also meet the performance measurement.
(OH)
The Healthcare Effectiveness Data and Information Set (HEDIS®) is one of healthcare’s most widely used performance improvement tools. The National Committee for Quality Assurance (NCQA) collects HEDIS data from health plans and other healthcare organizations to create annual health outcome surveys. Health plans use HEDIS data to measure performance and identify opportunities for improvement.
HEDIS includes more than 90 measures across multiple domains of care. These measures relate to public health issues, including (and not limited to) asthma medication use, blood pressure control, cancer screening, diabetes care, heart disease, and smoking and tobacco use cessation.
Eye Exam for Patients With Diabetes (EED) – Effectiveness of Care HEDIS Measure
Eye Exam for Patients With Diabetes (EED) is a specific HEDIS measure that requires health plans offering commercial, Medicaid, and Medicare plans to report the percentage of members with diabetes who had a dilated or retinal eye exam.
Measurement Definition:
Patients ages 18–75 with diabetes (Type 1 or Type 2) who received screening or monitoring for diabetic retinal eye disease:
- Retinal or dilated eye exam by an eye care professional in the measurement year or,
- A negative retinal or dilated eye exam by an eye care professional in the year prior to the measurement year.
- Note: Fundus photography with interpretation and report and certain types of retinal imaging (CPT® codes 92227, 92228, 92250, 92260, and 92314) covered by Essential Medical Eye Care may also meet the performance measurement.
(OR)
The Healthcare Effectiveness Data and Information Set (HEDIS®) is one of healthcare’s most widely used performance improvement tools. The National Committee for Quality Assurance (NCQA) collects HEDIS data from health plans and other healthcare organizations to create annual health outcome surveys. Health plans use HEDIS data to measure performance and identify opportunities for improvement.
HEDIS includes more than 90 measures across multiple domains of care. These measures relate to public health issues, including (and not limited to) asthma medication use, blood pressure control, cancer screening, diabetes care, heart disease, and smoking and tobacco use cessation.
Eye Exam for Patients With Diabetes (EED) – Effectiveness of Care HEDIS Measure
Eye Exam for Patients With Diabetes (EED) is a specific HEDIS measure that requires health plans offering commercial, Medicaid, and Medicare plans to report the percentage of members with diabetes who had a dilated or retinal eye exam.
Measurement Definition:
Patients ages 18–75 with diabetes (Type 1 or Type 2) who received screening or monitoring for diabetic retinal eye disease:
- Retinal or dilated eye exam by an eye care professional in the measurement year or,
- A negative retinal or dilated eye exam by an eye care professional in the year prior to the measurement year.
- Note: Fundus photography with interpretation and report and certain types of retinal imaging (CPT® codes 92227, 92228, 92250, 92260, and 92314) covered by Essential Medical Eye Care may also meet the performance measurement.
(SC)
The Healthcare Effectiveness Data and Information Set (HEDIS®) is one of healthcare’s most widely used performance improvement tools. The National Committee for Quality Assurance (NCQA) collects HEDIS data from health plans and other healthcare organizations to create annual health outcome surveys. Health plans use HEDIS data to measure performance and identify opportunities for improvement.
HEDIS includes more than 90 measures across multiple domains of care. These measures relate to public health issues, including (and not limited to) asthma medication use, blood pressure control, cancer screening, diabetes care, heart disease, and smoking and tobacco use cessation.
Eye Exam for Patients With Diabetes (EED) – Effectiveness of Care HEDIS Measure
Eye Exam for Patients With Diabetes (EED) is a specific HEDIS measure that requires health plans offering commercial, Medicaid, and Medicare plans to report the percentage of members with diabetes who had a dilated or retinal eye exam.
Measurement Definition:
Patients ages 18–75 with diabetes (Type 1 or Type 2) who received screening or monitoring for diabetic retinal eye disease:
- Retinal or dilated eye exam by an eye care professional in the measurement year or,
- A negative retinal or dilated eye exam by an eye care professional in the year prior to the measurement year.
- Note: Fundus photography with interpretation and report and certain types of retinal imaging (CPT® codes 92227, 92228, 92250, 92260, and 92314) covered by Essential Medical Eye Care may also meet the performance measurement.
(UT)
The Healthcare Effectiveness Data and Information Set (HEDIS®) is one of healthcare’s most widely used performance improvement tools. The National Committee for Quality Assurance (NCQA) collects HEDIS data from health plans and other healthcare organizations to create annual health outcome surveys. Health plans use HEDIS data to measure performance and identify opportunities for improvement.
HEDIS includes more than 90 measures across multiple domains of care. These measures relate to public health issues, including (and not limited to) asthma medication use, blood pressure control, cancer screening, diabetes care, heart disease, and smoking and tobacco use cessation.
Eye Exam for Patients With Diabetes (EED) – Effectiveness of Care HEDIS Measure
Eye Exam for Patients With Diabetes (EED) is a specific HEDIS measure that requires health plans offering commercial, Medicaid, and Medicare plans to report the percentage of members with diabetes who had a dilated or retinal eye exam.
Measurement Definition:
Patients ages 18–75 with diabetes (Type 1 or Type 2) who received screening or monitoring for diabetic retinal eye disease:
- Retinal or dilated eye exam by an eye care professional in the measurement year or,
- A negative retinal or dilated eye exam by an eye care professional in the year prior to the measurement year.
- Note: Fundus photography with interpretation and report and certain types of retinal imaging (CPT® codes 92227, 92228, 92250, 92260, and 92314) covered by Essential Medical Eye Care may also meet the performance measurement.
(VA)
The Healthcare Effectiveness Data and Information Set (HEDIS®) is one of healthcare’s most widely used performance improvement tools. The National Committee for Quality Assurance (NCQA) collects HEDIS data from health plans and other healthcare organizations to create annual health outcome surveys. Health plans use HEDIS data to measure performance and identify opportunities for improvement.
HEDIS includes more than 90 measures across multiple domains of care. These measures relate to public health issues, including (and not limited to) asthma medication use, blood pressure control, cancer screening, diabetes care, heart disease, and smoking and tobacco use cessation.
Eye Exam for Patients With Diabetes (EED) – Effectiveness of Care HEDIS Measure
Eye Exam for Patients With Diabetes (EED) is a specific HEDIS measure that requires health plans offering commercial, Medicaid, and Medicare plans to report the percentage of members with diabetes who had a dilated or retinal eye exam.
Measurement Definition:
Patients ages 18–75 with diabetes (Type 1 or Type 2) who received screening or monitoring for diabetic retinal eye disease:
- Retinal or dilated eye exam by an eye care professional in the measurement year or,
- A negative retinal or dilated eye exam by an eye care professional in the year prior to the measurement year.
- Note: Fundus photography with interpretation and report and certain types of retinal imaging (CPT® codes 92227, 92228, 92250, 92260, and 92314) covered by Essential Medical Eye Care may also meet the performance measurement.
What are CPT Category II Codes?
- CPT Category II codes are tracking codes which facilitate data collection related to quality and performance measurement. They allow providers to report services based on nationally recognized, evidence-based performance guidelines for improving quality of patient care.
- CPT Category II codes describe clinical components, usually evaluation, management, or clinical services.
- Category II codes are not to be used as a substitute for Category I codes.
- CPT Category II codes are for reporting purposes only and are not separately reimbursable.
What are CPT Category II Codes?
Current Procedural Terminology (CPT®) Category II codes are informational, supplemental tracking codes that can be used for quality and performance measurement. These codes are intended to facilitate data collection about the quality of care for certain services (e.g., dilated or retinal eye exam) that support performance measures (e.g., Eye Exam for Patients With Diabetes (EED) HEDIS performance measure).
When VSP members with diabetes receive a dilated or retinal eye exam from a network doctor, in addition to billing the exam CPT code, VSP instructs doctors to bill the appropriate supplemental CPT Category II code, which can be used for HEDIS performance measurement.
Including HEDIS supplemental data on VSP claims strengthens the role doctors of optometry have in their patients' healthcare and highlights the impact they have on protecting their patients' vision and overall health. In addition, when VSP network doctors include CPT Category II codes on claims, this data can be securely delivered to VSP health plan clients, reducing the administrative burden of medical record chart reviews for doctors and their staff.
- Category II codes are not to be used as a substitute for Category I codes. CPT Category II codes are for reporting purposes only and are not separately reimbursable. Bill CPT Category II codes with a $0.00 charge amount.
- If you receive a claim denial, your reporting code will still be included in the quality measure.
(WA)
The Healthcare Effectiveness Data and Information Set (HEDIS®) is one of healthcare’s most widely used performance improvement tools. The National Committee for Quality Assurance (NCQA) collects HEDIS data from health plans and other healthcare organizations to create annual health outcome surveys. Health plans use HEDIS data to measure performance and identify opportunities for improvement.
HEDIS includes more than 90 measures across multiple domains of care. These measures relate to public health issues, including (and not limited to) asthma medication use, blood pressure control, cancer screening, diabetes care, heart disease, and smoking and tobacco use cessation.
Eye Exam for Patients With Diabetes (EED) – Effectiveness of Care HEDIS Measure
Eye Exam for Patients With Diabetes (EED) is a specific HEDIS measure that requires health plans offering commercial, Medicaid, and Medicare plans to report the percentage of members with diabetes who had a dilated or retinal eye exam.
Measurement Definition:
Patients ages 18–75 with diabetes (Type 1 or Type 2) who received screening or monitoring for diabetic retinal eye disease:
- Retinal or dilated eye exam by an eye care professional in the measurement year or,
- A negative retinal or dilated eye exam by an eye care professional in the year prior to the measurement year.
- Note: Fundus photography with interpretation and report and certain types of retinal imaging (CPT® codes 92227, 92228, 92250, 92260, and 92314) covered by Essential Medical Eye Care may also meet the performance measurement.
(WV)
The Healthcare Effectiveness Data and Information Set (HEDIS®) is one of healthcare’s most widely used performance improvement tools. The National Committee for Quality Assurance (NCQA) collects HEDIS data from health plans and other healthcare organizations to create annual health outcome surveys. Health plans use HEDIS data to measure performance and identify opportunities for improvement.
HEDIS includes more than 90 measures across multiple domains of care. These measures relate to public health issues, including (and not limited to) asthma medication use, blood pressure control, cancer screening, diabetes care, heart disease, and smoking and tobacco use cessation.
Eye Exam for Patients With Diabetes (EED) – Effectiveness of Care HEDIS Measure
Eye Exam for Patients With Diabetes (EED) is a specific HEDIS measure that requires health plans offering commercial, Medicaid, and Medicare plans to report the percentage of members with diabetes who had a dilated or retinal eye exam.
Measurement Definition:
Patients ages 18–75 with diabetes (Type 1 or Type 2) who received screening or monitoring for diabetic retinal eye disease:
- Retinal or dilated eye exam by an eye care professional in the measurement year or,
- A negative retinal or dilated eye exam by an eye care professional in the year prior to the measurement year.
- Note: Fundus photography with interpretation and report and certain types of retinal imaging (CPT® codes 92227, 92228, 92250, 92260, and 92314) covered by Essential Medical Eye Care may also meet the performance measurement.
What are CPT Category II Codes?
- CPT Category II codes are tracking codes which facilitate data collection related to quality and performance measurement. They allow providers to report services based on nationally recognized, evidence-based performance guidelines for improving quality of patient care.
- CPT Category II codes describe clinical components, usually evaluation, management, or clinical services.
- Category II codes are not to be used as a substitute for Category I codes.
- CPT Category II codes are for reporting purposes only and are not separately reimbursable.
What are CPT Category II Codes?
Current Procedural Terminology (CPT®) Category II codes are informational, supplemental tracking codes that can be used for quality and performance measurement. These codes are intended to facilitate data collection about the quality of care for certain services (e.g., dilated or retinal eye exam) that support performance measures (e.g., Eye Exam for Patients With Diabetes (EED) HEDIS performance measure).
When VSP members with diabetes receive a dilated or retinal eye exam from a network doctor, in addition to billing the exam CPT code, VSP instructs doctors to bill the appropriate supplemental CPT Category II code, which can be used for HEDIS performance measurement.
Including HEDIS supplemental data on VSP claims strengthens the role doctors of optometry have in their patients' healthcare and highlights the impact they have on protecting their patients' vision and overall health. In addition, when VSP network doctors include CPT Category II codes on claims, this data can be securely delivered to VSP health plan clients, reducing the administrative burden of medical record chart reviews for doctors and their staff.
- Category II codes are not to be used as a substitute for Category I codes. CPT Category II codes are for reporting purposes only and are not separately reimbursable. Bill CPT Category II codes with a $0.00 charge amount.
- If you receive a claim denial, your reporting code will still be included in the quality measure.
(TX)
Follow all referral protocols set forth by your patient’s health plan for any services beyond the scope of the patient’s VSP plan. Typically, an HMO requires that patient referrals be coordinated by the primary care physician (PCP). However, a PPO usually allows patients to receive care from any medical provider without a PCP referral. Check Client Detail pages for any specific instructions or exceptions.
What are CPT Category II Codes?
- CPT Category II codes are tracking codes which facilitate data collection related to quality and performance measurement. They allow providers to report services based on nationally recognized, evidence-based performance guidelines for improving quality of patient care.
- CPT Category II codes describe clinical components, usually evaluation, management, or clinical services.
- Category II codes are not to be used as a substitute for Category I codes.
- CPT Category II codes are for reporting purposes only and are not separately reimbursable.
What are CPT Category II Codes?
Current Procedural Terminology (CPT®) Category II codes are informational, supplemental tracking codes that can be used for quality and performance measurement. These codes are intended to facilitate data collection about the quality of care for certain services (e.g., dilated or retinal eye exam) that support performance measures (e.g., Eye Exam for Patients With Diabetes (EED) HEDIS performance measure).
When VSP members with diabetes receive a dilated or retinal eye exam from a network doctor, in addition to billing the exam CPT code, VSP instructs doctors to bill the appropriate supplemental CPT Category II code, which can be used for HEDIS performance measurement.
Including HEDIS supplemental data on VSP claims strengthens the role doctors of optometry have in their patients' healthcare and highlights the impact they have on protecting their patients' vision and overall health. In addition, when VSP network doctors include CPT Category II codes on claims, this data can be securely delivered to VSP health plan clients, reducing the administrative burden of medical record chart reviews for doctors and their staff.
- Category II codes are not to be used as a substitute for Category I codes. CPT Category II codes are for reporting purposes only and are not separately reimbursable. Bill CPT Category II codes with a $0.00 charge amount.
- If you receive a claim denial, your reporting code will still be included in the quality measure.