We hope you’ve safely recovered from the earthquakes. Here at Envolve, we intend to stay up to date with CMS guidance on these emergencies as they arise.

DID YOU GET COVERAGE?

Current CMS emergency information can be found here:

CMS CURRENT EMERGENCIES

• If a member chooses to use a frame they already own and only receives new lenses from a provider, a provider cannot submit a claim for frame reimbursement (V2020).
• A provider may not file claims for services that were not rendered.
• Envolve recommends asking patients to sign when they pick up their glasses to establish proof of dispensing.
• Usual & Customary: Charges are considered reasonable, usual and customary if they match the general prevailing cost of that service within your geographic area. Usual & Customary charges are not invoice costs.
• Usual & Customary charges for the same lens and lens add-ons should never vary based on the size of a members allowance.
• Other reimbursement methodologies offer invoice cost with the submission of the laboratory invoice plus an established dispensing fee fee or additional percentage.

Other Provider Forms Updated

In an effort to improve the experience of our providers, we’ve updated many of the forms you use to submit changes to Envolve Vision. Before making your next submission, please visit our website to be sure you’re using the latest version:

ENVOLVE VISION FORMS

Did you know that several requests can be submitted electronically?

Visit https://visionbenefits.envolvehealth.com/PUF_Update.aspx for more information. If you have questions, please contact Customer Service.

Envolve Vision is committed to equipping providers with the best tools possible to support their administrative needs for submitting claims. Envolve Vision follows all CMS claims submission guidelines and HIPAA coding Standards. Critically important to you receiving proper claim payment is that all services provided must be included on the CMS 1500 claim form and billed amounts should be consistent with the provider’s usual and customary charges. Claims missing proper details are subject to audit. Proper claim coding should include all hardware features (i.e. frame, lens, and lens add-ons) with the proper number of units for each item. Please refer to your Provider Manual Section III: Claims, page 14 – 22, for further details.

The manual can be found here:

ENVOLVE VISION PORTAL

Envolve Vision offers participating providers access to our 24/7 provider portal, Eye Health Manager, to:

• Verify member benefits and eligibility.
• File, manage, review, and check the status of your claims.
• View, search, request secure HIPAA-compliant prior authorizations.
• Download, research, and reprint EOPs.
• View office manual and plan specifics, etc.

Let Envolve Vision decrease your administrative burdens and register for access today at the Vision Benefits portal.

REQUEST ACCESS

In February and March 2020, Envolve sent emails to all contracted vision providers sharing the MMM and MCS 2020 Benefits, respectively. The information provided is only intended to be a summary, and is not a detailed description of the benefits. Before administering benefits to a member, you must verify the member’s eligibility at https://envolvevision.com/logon or or calling Envolve Customer Service at 844-833-1905 (MMM) or (855) 754-4943 (MCS).

In addition, for your convenience, you can access an electronic copy of the plan's specifications for each plan at https://envolvevision.com/logon.

For your convenience, you can access an electronic copy of the plan's specifications at https://visionbenefits.envolvehealth.com.

For more than 30 years, Envolve Vision has partnered with vision care providers across the country to administer eye care programs that meet the needs of their members. You are among 21,000+ unique eye care providers, including independent providers and popular retail chains, within our network. Thank you for partnering with us to provide quality vision services to your patients.