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

COVID-19 Update for Providers

Envolve Vision continues to closely monitor new information and guidance, including updates to risk assessment and treatment options, relating to the COVID-19 pandemic in coordination with applicable CMS, federal, and state guidance. We rely on you, our provider partners, to help ensure our members receive the care that they need.

The following updates and resources are provided to help you identify the virus and care for your patients during this time of heightened concern:

  • Updates to Envolve telehealth policies include expanded coverage through July 25, 2020. Any service that can be delivered virtually will be eligible for telehealth coverage. End date is subject to change as regulatory guidance evolves.
  • Know the symptoms of COVID-19. Please refer to the CDC’s Information for Healthcare Professionals about Coronavirus (COVID-19) webpage for updated information as it evolves. www.cdc.gov/coronavirus/2019-nCoV/hcp/index.html
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Medicaid and Medicare members should not be billed for services including fees to cover the costs of personal protective equipment such as: infection control fee, biohazard fee, miscellaneous fee, etc. If your office requires financial assistance, the Department of Health and Human Services (HHS) announced that eligible Medicaid and Children’s Health Insurance Program (CHIP) providers can apply to the Medicaid Targeted Distribution portion of the CARES Act Provider Relief Fund. To apply, please access the portal here.

HEDIS Tips: Diabetic Care Coordination

Envolve Vision is committed to improving the health of our community by helping people with diabetes lead healthier lives. Because of your vital role in patient health, we are asking for your assistance by facilitating preventive care through annual diabetic eye exams and reporting exam findings. Routine retinal evaluation is recommended to reduce the risk of diabetes-related blindness. While examinations do not require prior authorization, please be sure to adhere to Envolve Vision clinical policies regarding medical necessity.

Using these codes may help reduce the need for medical record reviews:

65091, 65093, 65101, 65103, 65105, 65110, 65112, 65114, 67028, 67030, 67031, 67036, 67039-67043, 67101, 67105, 67107, 67108, 67110, 67113, 67121, 67141, 67145, 67208, 67210, 67218, 67220, 67221, 67227, 67228, 92002, 92004, 92012, 92014, 92018, 92019, 92134, 92201, 92202, 92227, 92228, 92230, 92235, 92240, 92250, 92260, 99203-99205, 99213-99215, 99242-99245
CPT ll
2022F, 2023F-2026F, 2033F, 3072F*
S0620, S0621, S3000
Diagnosis Code (diabetes without complications):
E10.9, E11.9, E13.9

*Please remember that 3072F should be included in your claim filing to indicate no evidence of diabetic retinopathy in the prior year, when applicable.

For questions regarding diabetic care coordination, call Envolve Vision Customer Service Center at 800-531-2818.

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Vision Care by the Numbers

Envolve Vision Proudly Serves


States + Puerto Rico




Medicaid Lives


Health Plans


Medicare Lives


Health Insurance Marketplace Lives

Review Clinical Criteria

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The Envolve Vision clinical criteria, policies, and procedures are available by logging into Eye Health Manager. From the Provider Resources drop-down, select Policies and Procedures, and then Utilization Management. If you do not have access to Eye Health Manager, register for access at envolvevision.com/requestaccess.


All eye doctors are re-credentialed every 36 months unless otherwise requested by the payor or required by local regulation. Reminder notices are distributed at three months and one month prior to the expiration of the eye doctor's credentials.

Member Eligibility

As a reminder, Envolve Vision strongly encourages verifying member eligibility prior to rendering services. Providers may verify eligibility through Eye Health Manager at envolvevision.com/logon or by calling Customer Service at the number provided for your market.

PCP Referrals Not Required

As a reminder, referrals from a Primary Care Physician (PCP) are not required for a member to schedule an eye exam with any participating optometrist or ophthalmologist. Should you have any questions, please contact Customer Service.

Confirm Access to Care Standards

Doctors are required to complete all routine eye exams and follow all access to care standards. Doctors must be able to offer appointments within the appointment wait times established by state guidelines and detailed within the Envolve Vision provider manual located in Eye Health Manager.

Provider Care Standards by State

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Routine Eye Exam

Within 14 days

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Sub-Acute Problem

Within 14 days

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Chronic Problem

Within 21 days

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Urgent (non-life-threatening)

Within the same office day

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All Other States
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Routine Eye Exam

Within two (2) weeks

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Sub-Acute Problem

Within two (2) weeks

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Chronic Problem

Within four (4) weeks

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Urgent (non-life-threatening)

Within the same office day

Update Your Information for the Provider Directory

Please verify that your office information is up-to-date – including office hours or contact information that may have recently changed. You have four ways to update your information for the Provider Directory:

Our Medicare Advantage and Health Insurance Marketplace Plans

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.

Ambetter logo

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 22,000+ 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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