Pricing and Payment

VSP will pay your lab for base lenses according to the confidential bid prices mutually agreed upon.  Laboratory bid prices are listed in your Laboratory and License Agreement and cover three categories of lenses.

• Single Vision—single vision base lens prices include standard 1.50 plastic and crown glass lenses in non-aspheric styles.
• Bifocal—bifocal base lens prices cover all standard segment styles (excluding blended and occupational, but including Progressives) up to and including 45 mm on Signature and Choice Plans.
• Trifocal/Other—this category covers all standard trifocal styles (excluding occupational), up to and including 35 mm on Signature Plan.  It also includes a sub-category called “lenticular.”  For VSP billing purposes, lenses considered “lenticular” are those designed for aphakic patients (lenticular and hyper-aspheric) where the prescription indicates, as well as myodiscs for high minus patients (not including blended myodiscs).

Bid prices are intended to cover patients’ basic visual needs.  Lenses ordered in approved upgraded materials or with approved add-ons are paid according to the assigned Lens Enhancement Fee Schedule in addition to the appropriate base lens price.  Lens Enhancement Fee Schedules are assigned by plan, set by VSP, and apply to all contract labs.  Bid prices for base lenses vary according to your lab’s individual agreement with VSP.  Refer to the Options Explanations or Product Index for additional information about payment for lens enhancements.  Base lens prices and the fees VSP pays you for lens enhancements are subject to change at any time.  
 
The base lens prices your lab receives cover payment for all sphere and cylinder powers, add powers, ground-in prism, shipping, and consider the likelihood that some prescriptions will have to be remade due to doctor changes.  VSP pays you a price predicated on an average or composite lens per category, realizing that some orders will be relatively inexpensive to produce, while others will be more costly.  It is never acceptable to turn down an order because of its expense to acquire or process, even in circumstances where the job must be sub-contracted.

Pursuant to the provision that as a VSP contract lab, you agree and understand that some on-site audits/pricing reviews may be unannounced. You must make your pricing information available to VSP agents whenever requested during normal business hours.  Wholesale invoices and statements may be requested during these visits and are required according to your signed agreement with VSP.  Failure to comply with this requirement is grounds for removal from the VSP contract lab program and the termination of your agreement with VSP and/or resitution in an amount to be determined by VSP.

From time to time, VSP, at its discretion, may conduct pricing surveys.  You are required to comply with these requests and submit your information to us in a timely manner and in the requested format.

All pricing and promotional information we receive from your lab is maintained in a secure environment and held in confidence.   We will not share any lab’s pricing or marketing materials with persons outside of VSP or those within VSP who do not have a business need to see them.

Similarly, all information pertaining to the payment you receive from VSP is confidential and may not be shared with anyone outside your lab or those within your employ who do not have a business need to know how VSP reimburses your lab.  This stipulation is intended to pertain to base lens pricing and lens enhancement payments.

VSP pays contract labs for services and materials once per month through direct deposit.  The orders for which you are paid each month as well as doctors’ compensation are triggered when you complete an order in Eyefinity.  For this reason, it is imperative that you do this as soon as orders ship from your lab.  Payment will be denied on any order received over 180 days beyond the Date of Service.

Your funds are issued to the bank you have on file with us on the 11th or first business day thereafter. If the 11th falls on a weekend or holiday, they will be available to you when your bank releases them.  Payment includes all applicable sales and use taxes, which are detailed on the Sales Tax Summary. Your lab is accountable for remitting payment to the appropriate taxing authority.

Lab payment cycles terminate at or about the 26th day of each month.  You will be paid on the 11th of the following month for orders completed through this date.  Orders completed after the cut-off date will be reimbursed the following month.

A Notice of Direct Deposit and your Remittance Advice is available through eyefinity.com beginning the 11th day of each month.  It is your responsibility to retrieve all pertinent financial documentation from Eyefinity, including the Downloadable Payment File available for automated account reconciliation, Remittance Advice in pdf format, Sales Tax Register, and Sales Tax Summary.

PLEASE NOTE: The Downloadable Payment File is overwritten monthly. Be sure to download this file shortly after the 11th of each month and before the 11th of the following month. This file is not retrievable once it's overwritten.

Your remittance advice will contain message codes detailing the reasons behind unpaid claims.  If you have not received payment after two payment cycles, submit a Reconciliation Form to VSP.  If you expect payment for an order, but it does not appear on your Remittance Advice, it may be for one of the following reasons:

• The order was received by VSP after the monthly cut-off date.
• The order was returned to the doctor for missing information.
• The doctor or lab ID was incorrect.
• VSP did not receive the order.
• VSP is researching the patient’s eligibility.

Under certain circumstances, your Remittance Advice may show a negative balance.  This may be due to the correction of previously overpaid claims or claims originally paid to your lab in error.  Please download and maintain your files for record keeping purposes regardless.

It is advisable that you reconcile your lab payments each month. Any discrepancies in payment you discover can be investigated by submitting a completed Reconciliation Form to VSP within 180 days of the Date of Service. We suggest that you wait two payment cycles to inquire about unpaid claims, as they may be reimbursed during the following month’s cycle. Please email completed forms to InNetAdj@vsp.com.

Include all over-payments, under-payments, and denials on the form along with photocopies of the Materials Invoice and CMS forms for orders sent to you on paper. It is not necessary to provide this documentation for orders submitted through Eyefinity. VSP's Claim Services department will evaluate all claims you include on this form and notify you of our decisions. Please allow two months for your Reconciliation Form inquiries to be resolved.  Plexus Optix cannot correct claim issues over the telephone or investigate those received via fax, mail or email since this is handled by VSP's Claim Services department.  Any requests for consideration will not be made on orders that exceed the 180 day limit, unless the discrepancy is the direct result of an error made by VSP.

To make changes to an in-process order, please see the Lab Adjustment Manual for guidance:

Labs are required to use Direct Deposit to receive payment.  If you change your financial institution or account information, please send a completed VSP Direct Deposit Authorization Agreement to PlexusOptix in order to expedite your bank or account transfer in our systems.  We will not process any requests without the requisite form with authorization from an approved agent within your company.  No exceptions will be made.

Changes to your Direct Deposit take one complete payment cycle after we receive your completed form to take effect.

All VSP contract labs are responsible for maintaining financial documents in accordance with the laws governing your locality. Please check with your accountant regarding how long you are required to keep these files.