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

Puerto Rico Medicaid Registration

Envolve Vision Benefits of Puerto Rico notifies you about process updates to the Provider Registration Portal (PEP) for the Puerto Rico Medicaid Program. All providers that render services, bill, order, refer, and/or prescribe any health service to a Medicaid beneficiary under Vital Plan and/or Medicare Advantage Platino are required to enroll directly with the PRMP and register with the portal. PRMP has designated the following for Optometrist enrollment training as well as registration start and end dates.

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Training Start
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Registration Start
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Registration End
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Providers who fail to enroll by the deadline will not be eligible to participate in the PRMP in any role, including billing, rendering, or operating providers. Applications not submitted will expire after 30 days of inactivity.

If you have questions regarding your enrollment in the Puerto Rico Medicaid Program (PRMP), please submit your inquiry by email to: prmp-pep@salud.pr.gov

Click here to access the registration link on the Puerto Rico Medicaid website.

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Diabetic Care Coordination

Eye Management of Puerto Rico (EMPR) and Envolve Vision Benefits of Puerto Rico are 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 ask 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.

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

92002, 92004, 92012, 92014
CPT ll
S0620, S0621
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. Please visit envolvevision.com/logon to view medical necessity guidelines, eligible ICD coding information, and to verify member benefits and eligibility.

For questions regarding diabetic care coordination, call Envolve Vision’s Customer Service at
(844) 833-1905 (MMM) or (855) 754-4943 (MCS).

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Vision Care by the Numbers

Envolve Vision Proudly Serves. . .


States + Puerto Rico




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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.

Important Provider Documentation Requirements

Please follow these important documentation guidelines to maintain compliance with Envolve Vision clinical policies and procedures:

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Hand written signatures are required on all member records. Envolve Vision does not accept stamps as signatures.

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Please provide hardware invoices and detailed hardware descriptions in the member medical record.

Overall documentation in member records should meet the criteria for Preventive Routine Eye Exams and include all required exam elements, including:

  • History, including patient's mental and physical health status
  • Best corrected visual acuity (with refraction¹ when indicated) and visual fields
  • External examination including pupillary function, ocular alignment & motility
  • Slit-lamp biomicroscopy examination
  • Intraocular pressure measurement
  • Fundus examination

In addition, the billed provider signing the patient record should be an Envolve Vision participating provider.

¹Refractions are separately reportable unless specifically included with the description of a service (e.g. S0620 & S0621)

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

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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