ENVOLVE is loading

Get Envolved header

Envolve Vision is a leader in superior, tailored vision benefits and services for Medicaid, Medicare, and Marketplace member markets. Every quarter, we’ll share key news that you can use to best serve your patients.

COVID-19 Update for Providers

Envolve Vision is closely monitoring guidance from our health plans, states, and CMS to quickly respond to any disaster relief measures implemented. These actions will help to ensure that members receive the care they need. Please visit the Envolve Vision website for policy changes that may accompany the state of emergency declaration in your region.

Per the Centers for Disease Control (CDC) guidance, all providers should:

Mom and child wearing breathing masks applying hand sanitizer
exclamation icon

Be alert for patients who meet the criteria for persons under investigation.

hospital icon

Review your infection prevention and control policies and CDC's recommendations for healthcare facilities for COVID-19.

eye icon

Review the CDC Public Health Reminder that addresses routine eyecare visits.

phone icon

Know how to report a potential COVID-19 case or exposure to facility infection control leads and public health officials. Contact your local or state health department in the event a person is under investigation for COVID-19.

surgical mask icon

Refer to the Centers for Disease Control and Prevention and the World Health Organization for the most up-to-date recommendations about COVID-19, including signs and symptoms, diagnostic testing, and treatment information.

Puerto Rico Earthquake - State of Emergency

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.


MMM Puerto Rico guidance allowed Out of Network coverage for MMM PR members until 02/29/2020.

MCS Puerto Rico guidance allowed Out of Network coverage for MCS PR members until 03/28/2020.

Current CMS emergency information can be found here:


Vision Care by the Numbers

Envolve Vision Proudly Serves. . .


States + Puerto Rico




Medicaid Lives


Health Plans


Medicare Lives


Health Insurance Marketplace Lives

Eyewear Reimbursement Reminders

paper with claims
  • 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:


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.

Customer Service
Raisa Figueroa, Provider Relations Specialist (787) 908-1741
Joselito Abrew, Provider Relations Specialist (787) 946-2275
MMMPR - Member Eligibility and Claims Inquiries (844) 833-1905
MCS – Member Eligibility and Claims Inquiries (855) 754-4943


man testing eyes

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:


GOOD BILLING PRACTICE: Lines for lens modification or add-ons in D., Modifiers for right and left lenses in D., Quantity totals in G.

claims showing good practice

BAD BILLING PRACTICE: Only billing for Frames in D., Lens Modifiers and Add-ons not billed separately (Added into Frames amount line F.)


Are you registered with Eye Health Manager?

Access is everything.

paper with claims
claims showing bad practice

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.


Vision Benefits Summary for 2020

paper with claims

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.

About Envolve Vision

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.

Envolve Vision Benefits Logo