ENVOLVE is loading

Get Envolved header

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.

PROSHA Requires All Providers to Apply for Certification

The Puerto Rico Secretary of Labor and Human Resources issued guidance discussing the basic elements employers are required to include in their plans to limit employee exposure to COVID-19. These required elements are in compliance with the Puerto Rico Safety and Health in Employment Act (PROSHA).



MMM requires all providers, at office Tax ID level, to apply for a PROSHA Certification pursuant to Executive Order 2020-038 issued by the Governor on May 1, 2020.

This executive order allows certain commercial businesses to resume operations as long as they prepare COVID-19 Exposure Control Plans and submit to the Puerto Rico Department of Labor and Human Resources a self-certification that the business has done so. These businesses must also provide their employees with the required Personal Protective Equipment (PPE).

Review requirements at:


Dentist with a face mask and face screen

Have a Fraud, Waste, or Abuse Concern?

Just like you, Envolve Vision takes the detection, investigation, and prosecution of fraud, waste, and abuse seriously. We perform ongoing claims audits that in some cases may result in taking actions against those providers who, individually or as a practice, commit fraud, waste, or abuse. We make it easier for you to report any fraud-related concerns with a new email address for our Special Investigation Unit (SIU). This new mailbox will be used for fraud-related referrals, SIU inquiries, and provider correspondence.

Please use EBOSIU@envolvehealth.com going forward to make sure your concerns are handled as quickly as possible.

Billing for PPE

Medicaid and Medicare members should not be billed for services including fees to cover the costs of Personal Protection Equipment (PPE) such as infection control fee, biohazard fee, miscellaneous fee, etc.

Essilor Labs Offers Preferred Pricing

Did you know that as a valued Envolve Vision provider you get preferred pricing from Essilor Labs? Through our mutual partnership arrangement, Envolve Vision providers have full access to excellent laboratory service backed by Essilor’s commitment to meet your needs and help you grow your practice. When you use an Essilor Lab, you will receive low, fixed pricing on many standard lenses, materials, and upgrades. You are also entitled to 32-percent off the Essilor National Price List for any other items ordered. In order to receive the discount, please be sure to:

  • Select Envolve Vision on your order online; or
  • Notate “Envolve Vision” on your fax order form in the special instructions box; or
  • Inform the customer service representative that it is an Envolve Vision order.

See the list of participating Essilor Labs under the “Essilor Partnership Forms” section found at visionbenefits.envolvehealth.com/forms.aspx.

Our Utilization Management Guidelines

As part of our ongoing commitment to our members and providers, we affirm the following:

  • Envolve Vision Utilization Management decision-making is based only on appropriateness of care and service and existence of coverage.
  • Envolve Vision does not specifically reward practitioners or other individuals for issuing denials of coverage.
  • Financial incentives for Utilization Management decision-makers do not encourage decisions that result in underutilization.

Thank you for all that you do to make member health a priority!

Dentist with a face mask and face screen

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.

92002, 92004, 92012, 92014
CPT ll
3072F* HCPCS: 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.

For questions regarding diabetic care coordination, contact Envolve Vision Customer Service at (855) 754-4943.

Deadline for Optometrists to Register for Puerto Rico Medicaid ID is Oct. 19

The Government of Puerto Rico Department of Health Medicaid Program has established October 19, 2020, as the deadline for optometrists to register for a Puerto Rico Medicaid ID. All providers who render, bill for, order, prescribe, or refer services for Medicaid beneficiaries under the Government Health Plan (Vital or Medicare Platino Plans) for services covered under the Medicaid State Plan must enroll directly with the Puerto Rico Medicaid Program (PRMP) through the Provider Enrollment Portal (PEP). All providers that are required to be indicated on a claim or encounter must enroll to be eligible for federal funding. If you provide services to MMM and/or MCS Platino members you are required to comply with this request to continue to receive payment for services rendered.


Vision Care by the Numbers

Envolve Vision Proudly Serves. . .


States + Puerto Rico




Medicaid Lives


Health Plans


Medicare Lives


Health Insurance Marketplace Lives

Be Sure to Review Clinical Policies Before Completing Services

Envolve Vision clinical criteria, policies, and procedures are available by logging into Eye Health Manager at visionbenefits.envolvehealth.com/logon.aspx. 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

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.

Envolve Vision Benefits Logo