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VSP Plans

Access & Access Indemnity Plans

The Access and Access Indemnity Plans provide discounts to patients for basic materials and services. 

Doctors are instructed to order Access and Access Indemnity orders from your lab on a private paper order form or through Eyefinity.

Billing
Bill doctors privately for Access and Access Indemnity orders.

VSP/Choice/Advantage Exam Plus with Allowances

The Advantage Exam Plus with Allowances Plan was designed for the health plan market.

Orders

Doctors are instructed to order Exam Plus with Allowances Plans orders from your lab on a private paper order form or through Eyefinity.

Billing
Bill doctors on a private invoice for Exam Plus with Allowances Plan orders. VSP reimburses doctors directly for these orders.

If you are a participating Advantage Exam Plus with Allowances Plan lab, charge according to the Advantage Exam Plus with Allowances Plan Fee Schedule. Any item not listed on that fee schedule should be billed to the doctor according to your private add-on price for that product.

To determine your private add-on price, deduct your lab’s private price for the base lenses from your private price for the material ordered. For example, if a doctor orders a pair of progressive lenses and your private price for the progressives is $100.00 and your private price for bifocals (base lens) is $30.00, charge the doctor $70.00 for the add-on ($100-$30=$70) as well as the bifocal fee listed on the Advantage Exam Plus with Allowances Plan fee schedule.

If you are not a participating Advantage Exam Plus with Allowances Plan lab and would like to be included on the list of labs agreeing to charge according to the fixed fee schedule, please contact Plexus Optix at 916.851.4900 or email us at plexusoptix@vsp.com for further information.

Choice/Advantage Plans

The VSP Choice/Advantage Plans are a modified version of the VSP Signature Plan. These high quality plans are versatile and cost competitive.

Orders
Choice/Advantage Plan orders are generally submitted to your lab through Eyefinity.

Billing
VSP will pay you your base lens prices and Choice/Advantage Plan option fees for materials ordered and supplied to VSP doctors.

Cigna

Cigna vision plans differ from VSP’s Choice Plans.

Orders
Cigna orders will indicate a Choice benefit type and require special procedures if accompanied by comment codes L020 or L098.

Orders submitted through eClaim must be processed and completed as normal, but billed to the doctor privately.

Doctors are instructed to order materials from your lab on a private paper order form or through Eyefinity when comment codes L020 or L098 appear.

If the order does not contain one of these comment codes, process it as you would a Signature or Choice Plan order, according to the benefit type indicated.

Billing
Bill doctors on a private invoice for orders with comment codes L020 or L098, otherwise, bill according to your Signature or Choice Plan methods. 

Computer Vision Care (CVC)

VSP’s CVC Plan is intended to provide materials to patients who work extensively at a computer.

Orders
Orders for CVS lenses are identified by “CVC” in the benefit type box.  Process and complete these orders per normal procedures.

Lens coverage on CVC orders includes the following:

  • Single Vision, Bifocal, and Trifocal lenses designed for computer use
  • Single Vision, Bifocal, and Trifocal lenses that differ from the patient’s dress wear by 0.50 or more diopters. 
  • Near Variable Focus Lenses (VSP lens enhancement code IA or IL) are covered
  • Patients are covered for eyesizes up to and including 60 mm

The materials listed below are excluded from CVC benefits, although certain group exceptions may occur.  Please refer to the patient’s option information for coverage.  

  • Dress wear glasses in lieu of computer glasses
  • Tints greater than 20%
  • Contact Lenses
  • Two pairs of single vision lenses in lieu of bifocals
  • Non-covered lens options (e.g. photochromic, sunglasses, and plano lenses)

CVC coverage also mandates that:

  • Patients must be currently eligible to receive lenses to obtain materials
  • Coordination of benefits is not permitted
  • If an “S” appears in the tint position on a patient’s plan grid, he or she may receive a rose or pink #1 or #2 tint or a rose or pink tint that does not exceed 20% absorption—these patients may elect to incur the extra cost of obtaining another color as long as the absorption level remains within the 20% limitation
  • If an “N” appears in any grid position, the option is not allowed and payment for materials will be denied

Essentials

The Essentials Plan is a modified version of the VSP Signature Plan. These high quality plans are versatile and cost competitive.

Orders
Essentials Plan orders are generally submitted to your lab through Eyefinity.

Billing
VSP will pay you your base lens prices and Choice/Advantage Plan option fees for materials ordered and supplied to VSP doctors.

Interim Benefits

Interim Benefits are an optional VSP WellVision® enhancement that provides coverage for services and materials obtained when a member is not eligible for services or materials under their regular plan. 

Patients are eligible if it has been at least 12 months since their last exam and there is a significant change in prescription. 

Interim Benefits may be covered for an exam, frame, and an additional pair of lenses, including elective contact lenses.  The services or materials covered and the criteria for approving interim benefits may vary by group.

Orders
Doctors are informed if a patient has interim benefits through a comment code.  Paper orders will be submitted to your lab with a Materials and Interim Benefits Pre-Certification Request form attached.  Complete the order and send this form to VSP for Payment.  Doctors are required to obtain authorization from the VSP Provider Services Support Line for orders submitted through Eyefinity.

Billing
VSP will pay your lab for materials provided.

Medicaid – All States Except California, South Carolina and Virginia

The Medicaid plan offers low-cost vision coverage to patients.

Orders
If you receive a VSP Materials Invoice and CMS-1500 form for a Medicaid order, return them to the doctor and proceed with the job as you would a private order.  Orders submitted through eClaim must be processed and completed per your normal means, but billed as a private order.

Doctors are instructed to order Medicaid orders from your lab on a private paper order form or through Eyefinity.  On paper orders, the doctor will write “Medicaid” and include the patient’s authorization number.

Billing
Bill doctors on a private invoice for Medicaid orders.  VSP reimburses doctors directly for these orders.

If you are a participating National Medicaid Plan lab, charge according to the National Medicaid Plan Fee Schedule.  Any item not listed on that fee schedule should be billed to the doctor according to your private add-on price for that product. 

To determine your private add-on price, deduct your lab’s private price for the base lenses from your private price for the material ordered.  For example, if a doctor orders a pair of progressive lenses and your private price for the progressives is $100.00 and your private price for bifocals (base lens) is $30.00, charge the doctor $70.00 for the add-on ($100-$30=$70) as well as the bifocal fee listed on the National Medicaid Plan Fee Schedule.

If you are not a participating National Medicaid Plan lab and would like to be included on the list of labs agreeing to charge according to the fixed fee schedule, please contact Plexus Optix at plexusoptix@vsp.com for further information.

Medicaid – CA (Medi-Cal)

The State of California has mandated that certain Medi-Cal orders be completed by Prison Industry Authority [PIA] labs.  It is the doctor's responsibility to check the patient's aid code before sending Medi-Cal orders to a lab. 

If you receive an order with Medi-Cal in the Benefit Type box, you may process it and bill the doctor privately or according to the National Medicaid Plan Fee Schedule. If you are a participating California Medicaid lab, it is advisable that you contact the doctor to verify that the order does not require the use of a PIA lab.

Plano

Plano benefits provide a frame and plano lenses to members of certain groups.

Orders
You can recognize a Plano plan by the word "Plano" in the Benefit Type box.  If the benefit type is not Plano, but 0.00 is indicated in the sphere field, please call VSP at 916.851.4900 to verify that the patient is eligible for Plano lenses.

Billing
VSP will pay you for materials supplied to VSP doctors.

Repair

VSP’s Repair Plan allows a patient’s frames or lenses to be repaired or replaced.

Orders
Orders are identified by the word “Repair” indicated in the Benefit Type box.  After you complete the repair or replacement of the lenses and/or frame, complete the order per your normal means.

Billing
VSP will pay you for the materials and/or services you provide on Repair orders.

Additional Pair

Additional Pair plans offer an additional pair of glasses under the same plan as the first pair.  Process these orders as you would under the main plan (e.g., Signature).

Signature Plan

The Signature Plan uses set fees for prescriptions and offers a choice of approximately 80 options.  All VSP contract labs participate in the Signature Plan, which offers competitive prices to VSP members and groups.

Orders
Signature Plan orders are generally submitted to your lab through Eyefinity.

Billing
VSP will pay you your base lens prices and Signature Plan option fees for materials ordered and supplied to VSP doctors.

State of California

The coverage provided for the State of California is either VSP Choice or VSP Advantage Plan.

Orders
Date of Service on or after 01/01/2015:
Choice/Advantage Plan orders are generally submitted to the lab through Eyefinity.

Billing
Date of Service on or after 01/01/2015:
VSP will pay you your base lens prices and Choice/Advantage Plan option fees for material ordered and supplies to VSP doctors.

VSP Vision Savings Pass

The VSP Vision Savings Pass plan provides savings to the members and is a modified version of the VSP Choice plan.

Please follow the same instructions as the Choice/Advantage Plans