Online Help for the Following EBO Web Site Pages

If this Online Help does not answer your question, please call 1-800-368-4790

Help for the View Member Benefits Page
General Page Notes
This page allows you to view the benefits for the member selected. To select a member, either enter the ID number OR the Name and Date of Birth. The next page will display the member's coverage and whether the member is eligible for a routine exam and/or hardware on the date of service entered. If you have any problems, call 1-800-368-4790.
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Provider Information
  • Physician - For viewing benefits available, selecting any provider in your office will work. The providers in the drop down list are those who have signed up with Envolve Vision 's Online Web Site.
  • Plan - Select the plan this member has from the drop down list. If the plan is not on the list, then it means that the provider/office has not contracted with Envolve Vision for that plan.
  • DOS - Enter the Date of Service of the appointment you are checking for the member. This is required and must be today's date or a future date.
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Patient Information
  • Member ID - Enter the member's ID from the ID Card.   If you have problems finding the member, eliminate the last 3 characters.  Do not use hyphens or any other special characters. This is required to find a member.
  • Last Name - Enter the last name of the member. This is required to find a member.
  • DOB - Enter the Date of Birth for the member. This is required to find a member.
  • First Name, MI, - Enter the name of the member in the appropriate spaces. If you are not sure of the name, enter only the first part of the name you know, and the system will select names similar to the partial entry you entered. These are optional fields.
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Membership History
Carefully select which member you are searching for with the correct effective and termination dates. The Active Yes/No will help you determine the effective and terminated coverage records. Click on the member name with the coverage records you wish to use. Clicking on the Benefit Code will give you a summary of the benefit plan for this member. This same information will also be shown again on the next page.
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Member Benefits
  • Routine - This will show if the member has routine eye exam benefits with Envolve Vision and whether he/she is eligible on the date of service entered.
  • Hardware - This will show if the member has any hardware (frames, lenses or contacts) benefits with Envolve Vision and whether he/she is eligible on the date of service entered.
  • Benefit - This is a summary of the benefit plan this member has with Envolve Vision .
  • Disclaimer - Please read the disclaimer for the Member Benefits information.
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Help for the Claim Entry Screen
General Page Notes
This page allows you to submit claims for the provider and member selected. These claims are sent to OMV's claims system immediately upon submission. To select a member, either enter the ID number OR the Name and Date of Birth.
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Provider Information

  • Physician - Select the provider who has performed the service. The providers in the drop down list are those who have signed up with Envolve Vision 's Online Web Site.
  • Plan - Select the plan this member has from the drop down list. If the plan is not on the list, then it means that the provider/office has not contracted with Envolve Vision for that plan.
  • DOS - Enter the Date of Service of the claim you will be entering. This is not required but will help select the correct coverage record on the next page.
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Patient Information
  • Member ID - Enter the member's ID from the ID Card.   If you have problems finding the member, eliminate the last 3 characters.  Do not use hyphens or any other special characters. This is required to find a member.
  • Last Name - Enter the last name of the member. This is required to find a member.
  • DOB - Enter the Date of Birth for the member. This is required to find a member.
  • First Name, MI, - Enter the name of the member in the appropriate spaces. If you are not sure of the name, enter only the first part of the name you know, and the system will select names similar to the partial entry you entered. These are optional fields.
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Membership History
Carefully select which member you are searching for with the correct effective and termination dates. The Active Yes/No will help you determine the effective and terminated coverage records. Click on the member name with the coverage records you wish to use. Clicking on the Benefit Code will give you a summary of the benefit plan for this member.
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Claim Physician Information

  • Primary Diagnosis - Enter all of the diagnosis codes that will be related to the claim detail lines entered below.
  • Facilities - If a facility other than the provider's office is used, select it from the drop down list. Only facilities that are contracted with the plans that the provider is currently contracted with will be shown here. Leave blank if not applicable.
  • Place of Service - Use the drop down list to choose the place of service where the service was provided.
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Claim Services

  • Date of Service - Enter the From Date of Service for the procedure. The To Date of Service will automatically fill in.
  • TOS - Enter the Type of Service for the procedure, if applicable.
  • Modifiers - Enter up to 3 Modifiers if applicable.
  • Diagnosis Pointer - Enter the number, 1 through 8, that points to the diagnosis code entered above that is the primary diagnosis for that procedure.
  • Charges - Enter the amount the office is charging for the procedure(s).
  • Units - Enter the number of procedures that were performed or eye hardware that was delivered.
  • cpy del - Select cpy at the end of a blank line you wish to fill in with a copy of another line. Clicking on cpy will prompt you for a line # and enter the line # you wish to copy from. Select del at the end of a line you wish to delete.
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Account Information

  • Patient Account - Enter your office's patient account number. This number will be printed on the check and EOB form that is sent to your office and help you reference the member.
  • Authorization Number - Enter a referral number here if the member's plan requires a referral from his/her PCP. If you received an authorization from Envolve Vision , the system will automatically match the claim you submit with the authorization on file here at Envolve Vision . In this case, no number is needed.
  • Total Charge - This field is automatically calculated based on the total of the charge amounts entered on the detail lines.
  • Paid - Enter the amount the patient has paid.
  • Balance - This field is automatically calculated based on the Total Charge minus the Paid Amount.
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Service Billing Address
Select the correct Service Address for the claim you are submitting by clicking on the circle under Select. If the service address you should be using is not there or the service address is not listed with the correct billing address, please call for assistance at 1-800-840-7032.
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Claim Form
This form is shown with all the information you have entered. You can print this form out for your records by clicking on the PRINT CLAIM FORM button at the bottom of the page. Please check over the information carefully. The claim has not been submitted yet so you can use the Back button on your browser to change the information. When you have reviewed the information on the form and everything is correct, then click on the Continue button. Your claim will be immediately sent to Envolve Vision 's Claims Processing System.
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Claim Submission Status
Immediately after you have submitted your claim, a status message will appear if the claim was not accepted. The message will be CLAIM REJECTED. This rarely happens. If the claim is accepted, a claim number will be shown on top of the HCFA-like form. You may want to either print this out for your records. This will aid you when referring to the claim if you wish to research it later online or with Envolve Vision 's Customer Service. If the claim is rejected, it may be because the claim was inadvertently submitted twice. If you see Possible Duplicate then this is probably the case. To ensure that your original claim was submitted, use the Audit Tools to list the claims for today. If you see the claim you submitted in the Audit Tools report list, it has been successfully submitted to Envolve Vision .
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Help for the Claim Status Check
General Page Notes
This page allows you to view the claims for the member and provider selected. This page also allows you to select a denied claim and resubmit it with corrected information. To select a member, either enter the ID number OR the Name and Date of Birth.
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Provider Information

  • Physician - Select the provider who provided the services on the claim. The providers in the drop down list are those who have signed up with Envolve Vision 's Online Web Site.
  • Plan - Select the plan this member has from the drop down list. If the plan is not on the list, then it means that the provider/office has not contracted with Envolve Vision for that plan.
  • DOS - Enter the Date of Service of the claim you are seeking. If you are not sure, leave it blank.
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Patient Information
  • Member ID - Enter the member's ID from the ID Card.   If you have problems finding the member, eliminate the last 3 characters.  Do not use hyphens or any other special characters. This is required to find a member.
  • Last Name - Enter the last name of the member. This is required to find a member.
  • DOB - Enter the Date of Birth for the member. This is required to find a member.
  • First Name, MI, - Enter the name of the member in the appropriate spaces. If you are not sure of the name, enter only the first part of the name you know, and the system will select names similar to the partial entry you entered. These are optional fields.
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Membership History
Select which member you are searching for with the correct effective and termination dates. The Active Yes/No will help you determine the effective and terminated coverage records. Click on the member name with the coverage records (the time span) you wish to use. Clicking on the Benefit Code will give you a summary of the benefit plan for this member.
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Claims Listing
This listing will display claims that are on Envolve Vision 's Claims System, whether they have been received via the Web, EDI or paper. The claims displayed are based on the selection criteria you entered. Denied claims will have a checkbox to the left of the claim. Click this box to mark the claims you wish to resubmit with corrected information. Click on the Go button at the bottom after you have selected the claims you wish to resubmit. You will be prompted through each claim and you can change the information you wish. Note: no changes are allowed to Provider, Member, or Date of Service. Some of the fields on the report to note are:
  • DatePD (Date Paid) - If there is a date paid here, that will tell you that the claim has been processed (paid or denied) and which EOB (Explanation of Benefits) the claim was on. Information on how the claim was processed will be in fields Allowed and NetPd.
  • Dispositions - Directly below the claim's Service Date, a disposition reason will appear if the claim was denied or has been sent to another payer for payment. If the claim is currently pending or has been paid, no disposition message will appear.
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Help for the View Member Authorizations
General Page Notes
This page allows you to view the claims for the member and provider selected. To select a member, either enter the ID number OR the Name and Date of Birth.
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Provider Information

  • Physician - Select the provider who provided the services on the claim. The providers in the drop down list are those who have signed up with Envolve Vision 's Online Web Site.
  • Plan - Select the plan this member has from the drop down list. If the plan is not on the list, then it means that the provider/office has not contracted with Envolve Vision for that plan.
  • DOS - Enter the Date of Service of the authorization you are seeking. If you are not sure, leave it blank.
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Patient Information
  • Member ID - Enter the member's ID from the ID Card.   If you have problems finding the member, eliminate the last 3 characters.  Do not use hyphens or any other special characters. This is required to find a member.
  • Last Name - Enter the last name of the member. This is required to find a member.
  • DOB - Enter the Date of Birth for the member. This is required to find a member.
  • First Name, MI, - Enter the name of the member in the appropriate spaces. If you are not sure of the name, enter only the first part of the name you know, and the system will select names similar to the partial entry you entered. These are optional fields.
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Membership History
Carefully select which member you are searching for with the correct effective and termination dates. The Active Yes/No will help you determine the effective and terminated coverage records. Click on the member name with the coverage records (the timespan) you wish to use. Clicking on the Benefit Code will give you a summary of the benefit plan for this member.
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Authorization Listing
This report will list the authorizations for the member you entered with the basic information including whether the authorization is pending, approved or denied. Clicking View under referral letters will bring up the authorization letter and you will be able to view and print the letter.
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Help for the Claim Search
General Page Notes
This page allows you to search for claims with various criteria. The only fields that are required are the provider and the plan. Use any of the other fields to narrow down the results.
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Provider Information

  • Physician - Select the provider who provided the services on the claim. The providers in the drop down list are those that have signed up with Envolve Vision 's Online Web Site.
  • Plan - Select the plan this member has from the drop down list. If the plan is not on the list, then it means that the provider/office has not contracted with Envolve Vision for that plan.
  • Claim Number - If you know the claim number you are seeking, then enter it here. If you know the claim number, there is no reason to enter any other criteria.
  • DOS - If you know the date of service of the claim you are seeking, enter it here.
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Patient Information

  • Member ID - If you know the Member's ID, enter it here.   If you have problems finding the member, eliminate the last 3 characters.  Do not use hyphens or any other special characters.   Also you can use Name and Birthdate to find the member.
  • Member's Name - If you know any parts of the member's name, First Name, MI, or Last Name, enter it here.
  • SSN - If you know the social security number of the member, enter it here.
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Claims Listing
This listing will display all claims that are on Envolve Vision 's Claims System, whether they have been received via the Web, EDI or paper. The claims displayed are based on the selection criteria you entered. Some of the fields on the report to note are:
  • DatePD (Date Paid) - If there is a date paid here, that will tell you that the claim has been processed (paid or denied) and which EOB (Explanation of Benefits) the claim was on. Information on how the claim was processed will be in fields Allowed and NetPd.
  • Dispositions - Directly below the claim's Service Date, a disposition reason will appear if the claim was denied or has been sent to another payer for payment. If the claim is currently pending or has been paid, no disposition message will appear.
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Help for the Authorization Search
General Page Notes
This page allows you to search for authorizations with various criteria. Only the provider information is required, but use other fields to narrow down the results.
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Provider Information

  • Physician - Select the provider who requested the services on the authorization. The providers in the drop down list are those that have signed up with Envolve Vision 's Online Web Site.
  • Plan - Select the plan this member has from the drop down list. If the plan is not on the list, then it means that the provider/office has not contracted with Envolve Vision for that plan.
  • DOS - If you know the Date of Service of the Authorization you are seeking, enter it here.
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Patient Information

  • Member ID - If you know the Member's ID, enter it here.   If you have problems finding the member, eliminate the last 3 characters.   Do not use hyphens or any other special characters.   Also you can use Name and Birthdate to find the member.
  • Member's Name - If you know any parts of the member's name, First Name, MI, or Last Name, enter it here.
  • SSN - If you know the social security number of the member, enter it here.
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Authorization Listing
This report will list the authorizations for the criteria you entered with the basic information including whether the authorization is pending, approved or denied. Clicking View under referral letters will display the authorization letter and you will be able to view and print the letter.
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Help for the Claim Audit
General Page Notes
The Claims Audit Report will display claims that have been submitted through the Envolve Vision Web Site for the provider and date range that you select.
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Claims Audit Report Entry
Enter the selection criteria for the Web Claims you wish to view.
  • Physician - Select the physician from the drop down box whose claims you want to view.
  • Claim Audit Start Date - Enter the beginning of the date submitted range for viewing the claims.
  • Claim Audit End Date - Enter the end of the date submitted range for viewing the claims. The default is today's date.
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Claims Audit Report
The Claims Audit Report will display ONLY claims that have been submitted through the Envolve Vision Web Site for the provider and dates submitted that you entered. Only information will be listed as you have submitted it. To see the claim as it is in our claims processing system, go to either Claim Status Check or Claim Search. Clicking on the Details link will show the claim with all the information from the time of submission.
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Help for the Reprint EOBs
General Page Notes
Reprint EOBs will allow you to reprint past EOBs. This page also has the capability to export the EOB data to an Excel spreadsheet for additional manipulation.
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Reprint EOB Entry
Enter the selection criteria for the EOB you wish to print or export.
  • Check Date - Enter the check date (EOB) that you want to have reprinted.
  • Location - Select the billing address for the EOB you want to have reprinted.
  • EOB / EOB Export - Select whether you want the information on a report (EOB w/rvu) or in an Excel file (EOB (Export Only). Then choose the month and year.
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EOB Report
Some of the fields on the report to note are:
  • DatePD (Date Paid) - If there is a date paid here, that will tell you that the claim has been processed (paid or denied) and which EOB (Explanation of Benefits) the claim was on. Information on how the claim was processed will be in fields Allowed and NetPd.
  • Details - Clicking on this link will show the claim exactly as you submitted it.
  • Dispositions - Directly below the claim's Service Date, a disposition reason will appear if the claim was denied or has been sent to another payer for payment. If the claim is currently pending or has been paid, there will be no message.
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EOB Export
How to run the export:
  • When you click on GO, the Web Site will take you to Crystal Report Viewer. After the data loads, click on the icon of an envelope with a red arrow.
  • Change the Export Format to MS Excel (.xls)
  • Type in the directory with the new file name OR use Browse to find the directory and then type in the new file name in Enter File_name
  • Click on OK, and then you should see the Message "Export Completed"
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Help for using Adobe Acrobat Reader to view PDF Documents
Loading Adobe Acrobat
If you don't have Adobe Acrobat Reader on your PC or wish to upgrade to a newer version, click on the Get Acrobat Reader Button in the right hand corner. This button will take you to the Adobe Acrobat Web site. In the left hand corner of the Web site, click on the link Text-Only Acrobat Reader Download Page. Next choose English from the list of languages. Then choose the link at the top of the page, which should be Acrobat Reader 7 with Search and Accessibility - English for Windows or higher... If you do not have one of the operating systems listed, then review the rest of the list to find your particular PC or Mac operating system. A File Download Message Box will come up. Follow the instructions to download Acrobat Reader on your PC. You will only have to do this one time.
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EOB Export
How to run the export:
  • When you click on GO, the Web Site will take you to Crystal Report Viewer. After the data loads, click on the icon of an envelope with a red arrow.
  • Change the Export Format to MS Excel (.xls)
  • Type in the directory with the new file name OR use Browse to find the directory and then type in the new file name in Enter File_name
  • Click on OK, and then you should see the Message "Export Completed"
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Using Adobe Acrobat
  • Adjusting the size of the document - First set the size of the print of the document. You can do this by either by clicking on View then use Zoom In and Zoom Out to get the size you desire. You can also use the + and - buttons to change the size.
  • Using Links - Any time you see a blue underlined text or number, that is a link to another part of the document. Clicking on that link will take to you the other part of the document.
  • Navigating through the document - Use the scroll bar on the right bar on the right side of the document or the back and forward buttons on the tool bar at the top.
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Help for Claim COB
COB

For COB information on this claim, please use the form to submit all required information. Below are some definitions to help you fill out the form.

Payer ID Payer ID numbers are used in health care to route payment through electronic means. The codes can be made up of numbers or letters, or a combination of the two.
Payer Sequence Code identifying the insurance carrier's level of responsibility for a payment of a claim
Filing Indicator Filing indicator is usually a 2 digit code made up of numbers or letters, or a combination of the two.
MOA Codes Medicare Outpatient Adjudication codes
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EOP / Remittance

For EOP / Remittance on this claim, please use the form to submit all required information. Below are some definitions to help you fill out the form.

Adjustment Group Code This is the Health care Claim Group code and is made up of 2 letters.
Adjustment Reason Code Reason codes used in the Physician Explanation of Payments and the Institutional Explanation of Payments.
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Help for the Authorization Entry Page
General Page Notes

This page allows you to submit authorizations to Envolve Vision for "non-urgent" medical surgical procedures that require a pre-authorization. Please do not use this page to enter urgent requests. Call 1-800-368-4790 for immediate assistance. Most of the authorizations will Pend waiting for review by Envolve Vision 's Utilization Management staff, however some cataract procedures may be approved on the spot accompanied with an approval letter you can immediately print. A decision will be made on all non-urgent requests within 2 working days of obtaining all necessary information. To check on the status of your submitted authorizations (including those you have submitted by fax), use View Authorizations or call 1-800-368-4790 during regular business hours (M-F 8:00-5:00).
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Provider Information (Eligibility)

  • Physician - Select the provider who has performed the service. The providers in the drop down list are those who have signed up with Envolve Vision 's Online Web Site.
  • Plan - Select the plan this member has from the drop down list. If the plan is not on the list, then it means that the provider/office has not contracted with Envolve Vision for that plan.
  • DOS - Enter the Date of Service of the claim you will be entering. This is not required but will help select the correct coverage record on the next page.
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Patient Information (Eligibility)
  • Member ID - Enter the member's ID from the ID Card.   If you have problems finding the member, eliminate the last 3 characters.  Do not use hyphens or any other special characters. This is required to find a member.
  • Last Name - Enter the last name of the member. This is required to find a member.
  • DOB - Enter the Date of Birth for the member. This is required to find a member.
  • First Name, MI, - Enter the name of the member in the appropriate spaces. If you are not sure of the name, enter only the first part of the name you know, and the system will select names similar to the partial entry you entered. These are optional fields.
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Member Coverage
Carefully select which member you are searching for with the correct effective and termination dates. The Active Yes/No will help you determine the effective and terminated coverage records. Click on the member name with the coverage records you wish to use. Clicking on the Benefit Code will give you a summary of the benefit plan for this member.
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Contact Information

  • Date - The date will automatically fill in and cannot be changed.
  • Office Contact - Put the name of the person who should be contacted if additional information is needed and to notify whether the procedure(s) was approved.
  • Phone/Fax - Put the phone number and fax number for the contact person above.
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Provider Information (Authorization)

  • Provider ID and Name - This will automatically default to the last provider who was selected. Use the drop down arrow to the right of the Name to change the name of the Provider of Service.
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Patient Information (Authorization)

  • Name, DOB, ID#, HMO, Group - The current information for the Patient you selected is printed here. Next to the Patient Information label above this information, you will see the coverage dates. The date of service must be within this date span.
  • Other Insurer - If the patient (member) has any other coverage, please enter the name of the plan and any other information you have such as the subscriber number.
  • Date of Admit - Enter the date of admission if this is an inpatient procedure.
  • Date of Surgery - Enter the date that the surgery will be performed. The date must be greater than today's date. If the procedure is urgent, please call 1-800-368-4790 during regular business hours (M-F 8:00-5:00).
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Service Information

  • Place of Service - Use the drop down box to find the correct place of service for the procedure.
  • Facility - If the place of service is Inpatient Hospital, Outpatient Hospital, Emergency Room, or Ambulatory Surgical Center, then you must also pick a facility. All facilities that have contracted with insurance companies with whom your providers has also contracted will be listed here. If you think there is an error, please call 1-800-465-6972.
  • Service Location - Select the Office Location where the patient is being seen by the provider selected.
  • ICD - Enter in up to 3 ICD codes.
  • CPT/MOD/REF/QTY - For each CPT code, enter the modifiers, the reference to one the Diagnosis codes, and the quantity.
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PCP Information

  • PCP Information - If the member belongs to a plan that requires a PCP referral, enter that information here.
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Additional Clinical Information
Additional Clinical Information is required to determine whether the authorization is approved or denied. Please answer the questions correctly based on the information in the Patient's medical records. Additional information may be requested by phone that will have to be faxed to Envolve Vision .
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Authorization Submittal

This page notifies you that the authorization has been submitted to Envolve Vision and gives you a reference number to follow up on the Authorization if needed. Also note that the authorization is PENDED or APPROVED. If the authorization is approved, the application will take you directly to the Approval Authorization Letter. If you get the Approval Authorization Letter, there is no need for any further contact with Envolve Vision regarding this authorization. Most of the authorizations will PEND waiting for review by Envolve Vision 's Utilization Management staff. However some cataract procedures may be approved on the spot accompanied with an approval letter you can immediately print. A decision will be made on all non-urgent requests within 2 working days of obtaining all necessary information. To check on the status of your submitted authorizations (including those you have submitted by fax), use View Authorizations or call 1-800-465-6972. during regular business hours (M-F 8:00-5:00).
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