The VSP Authorization Process
Comprehensive eye exams like VSP’s WellVision Exam include an evaluation of the patient’s eye health and function, including how well the eyes focus and work together. Comprehensive eye exams also allow eye doctors to detect conditions that can cause. Vision Service Plan Attention: Claims Services P.O. Box 385018 Birmingham, AL. Submitting a Claim & I'm No Longer a VSP Member. Contact VSP member services at 800.877.7195 and ask for a Member Reimbursement form (VSP Out-Of-Network form). Send the form and a copy of your receipts to: Vision Service Plan Attention: Claims Services P.
To request a VSP authorization directly from My Vision Express:
1. Open the patient profile and click on the ‘Insurance’ tab.
2. Select the VSP plan that you want to use for the authorization.
3. Click on the ‘Authorizations’ sub-tab and select “Authorize New” from the ‘VSP’ drop-down.
4. In the VSP - Check Eligibility dialog that opens up, click the View Benefits & Authorize… button.
5. From the VSP – Authorize Benefit for a Patient dialog that opens up:
a. Use the ‘Select Benefit’ option list to select the plan to be used if more than one is available.
b. Specify the ‘Date of service’.
c. Select whether to authorize for ‘All Services Available’ or for a combination of ‘Exam’, ‘Lenses’, ‘Frame’ and ‘Contacts’ by checking the corresponding checkboxes.
d. Click the Authorize… button.
6. A Display Report dialog will ask you to select the authorization reports that you want to display. Make your selection and click OK to view the report or reports selected.
7. Back in the VSP – Authorize Benefit for a Patient dialog, click the Close button to finalize the request process.
The ‘Allowance type’ that you get in step 3 with the authorization for contact lenses will affect the orders as shown in Table 1 below:
Table 1: VSP Allowance Types | |||
MaterialService (CL exam copay with materials allowance) | ExamContacts (combined CL allowance) | Total Allowance | |
VSP Payment | Eye Exam: you will receive your assigned fee for the eye exam. CL Exam Services (F&E): you will be paid 85% of your usual and customary (U&C) fees, less the patient copay. CL Materials: you will be paid your U&C fees up to your patient’s CL materials allowance. | Eye Exam: you will receive your assigned fee for the eye exam. CL Exam Services (F&E) & Materials: you will be paid 85% of your U&C fees for exam services plus your U&C fees for materials up to your patient’s exam and contact lens allowance. CL Exam Services (F&E) Only (no materials): VSP will reimburse you up to $60. CL Materials Only (contact lens exam services received elsewhere): Your patient is not eligible for services; contact VSP at 800-615-1883 for more information. | You will be paid your exam and contact lens exam services (F&E) fees discounted by 15% plus your U&C fees for materials up to the patient’s total contact lens allowance. |
Balance Billing | Patient is responsible for the CL exam services copay or 85% of your U&C fees, whichever is less, and the difference between their allowance and U&C fee for materials. | Patient is responsible for the difference between their allowance and your discounted CL exam services (F&E) fee and U&C fee for materials. CL Exam Services (F&E) Only (no materials): Patient is responsible for your U&C fees for CL exam services (F&E) discounted by 15%, less the $60 paid by VSP. | Patient is responsible for the difference between their allowance and your discounted fees for the eye exam and contact lens exam services (F&E) plus your U&C fees for materials. |
Important! Determine your U&C fees for contact lens exam services (F&E), then add taxes if applicable (see chart above). Bill this amount on the claim. Follow your state tax guidelines. New Mexico doctors: Determine your total fees for services and materials. Bill this amount on the claim. | |||
To retrieve an existing VSP authorization from the Eyefinity website:
1. Open the patient profile and click on the ‘Insurance’ tab.
Eye Doctors That Take Vsp Ins
2. Select the VSP plan that you want to use for the authorization.
Vsp Copay Amount
3. Click on the ‘Authorizations’ sub-tab and select “Existing Auth” from the ‘VSP’ drop-down.
Vsp Exam Only
4. In the Retrieve Existing VSP Authorization dialog that opens up, type the ‘Authorization ID’ and click OK.