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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 state.

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

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

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

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

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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.

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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.

Coming Soon: WADD System to Help Reduce Claim Payment Denials

Envolve Vision is launching our new Web Adjudication Denial Detection (WADD) system this summer. Leveraging predictive adjudication technology, our website will review claims during the online submission process. The WADD system will highlight potential errors and show you how to take corrective action to decrease the likelihood of claim payment denials.

Doctors and staff will continue to have full control over the claim submission process and may choose to:




The new system will provide proactive feedback on which line of service may deny and why, which will prevent any later surprises following your claim submission. If you choose to accept the claim as is, you can simply close the WADD dialog box. If you have any concerns or additional information regarding your claims, you can add a message for one of our experienced claims examiners to review. Click here to view sample screenshots of the new system in action.

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HEDIS Awareness: Diabetic Retinal Exam

The Comprehensive Diabetes Care retinal exam is a measure across health plans of comprehensive diabetic care for these exams. This measure includes members ages 18-75 with diabetes (type 1 or 2) who had a retinal eye exam performed.

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Best practices for eye care professionals include:

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Schedule retinal or dilated eye exams every one to two years at a minimum.

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Inform patients of their risks of diabetic retinopathy.

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Outreach to schedule appointments to non-compliant members.

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Communicate any findings to the patient's primary care provider for comprehensive diabetic care coordination.

Vision Care by the Numbers

Envolve Vision Proudly Serves


States + Puerto Rico




Medicaid Lives


Health Plans


Medicare Lives


Health Insurance Marketplace Lives

New Claim Appeal/Reconsideration Request Form

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Envolve Vision has implemented a new Claim Appeal/Reconsideration Request Form. With implementation of the new request form, you’re no longer required to submit a CMS1500 form.

Visit the the Eye Health Manager Web Portal at


to access the form, which may be submitted via email or mail.

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.


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Are you registered with Eye Health Manager?

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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:


Thank You for Serving Our Members

Learn more about what’s under our care roof. Envolve Vision works with a variety of health plans to provide eye care benefits to Medicaid, Medicare, and Health Insurance Marketplace members across the country. Depending on your state, service area, and terms of your participating provider agreement, you may see members in at least one of the following plans, in addition to state-specific Medicaid plans:

AllWell Logo

Allwell is a licensed health maintenance organization (HMO) contracted with the Centers for Medicare & Medicaid Services (CMS) to provide medical and behavioral health services to dual-eligible members who are eligible for both Medicare and Medicaid. CMS also contracts with Allwell to provide Part D prescription medications to members enrolled in certain Medicare health plans that include a Part D benefit.

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Ambetter is a Qualified Health Plan (QHP) as defined in the Affordable Care Act (ACA) and is offered to consumers through the Health Insurance Marketplace.

Ascension Logo

Ascension Complete is a licensed health maintenance organization (HMO) contracted with the Centers for Medicare & Medicaid Services (CMS) to provide Part D prescription medications to members enrolled in certain Medicare health plans with a Part D benefit. Envolve currently services Ascension Complete members in Florida, Illinois, and Kansas.

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.

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