This is a reminder to enroll in the Puerto Rico Medicaid Program (PRMP) via the Provider Enrollment Portal (PEP). 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 PEP. Providers that are required to be indicated on a claim or encounter must enroll to be eligible for federal funding. Because 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.
Wave 8 provider types, which include vision centers, may register for web-based trainings for Medicaid enrollment through the end of 2020. Find other eligible provider types, registration information with dates, and further details in this PRMP letter dated Oct. 16, 2020.
The Envolve Vision clinical criteria, Provider Manuals, policies, and procedures are available by logging into the Eye Health Manager. Important reminders, notices, plan specifics, and provider manuals are located in the Provider Resources tab and communicated to providers via fax, mail, or email. To see the most recent vision clinical policies, log in to the PWP at envolvevision.com/logon. Choose Provider Resources from the dropdown menu on the left, then Policies and Procedures, and Utilization Management.
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. Please contact our Customer Service team with any questions.
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In order to provide culturally competent and accessible medical services, providers must ensure that members have access to medical interpreters, signers, and TTY services. Any services provided to facilitate communication are at no charge to the patient.
If you need TTY services for a patient, call
Envolve Vision has partnered with PaySpan Health to deliver Electronic Funds Transfers (EFTs), Electronic Remittance Advice (ERAs). PaySpan Health is a free solution to enable online presentment of remittance/vouchers, straightforward reconciliation of payments that empowers providers to reduce costs, speed secondary billings, improve cash flow, and help the environment by reducing paper usage.
How to Register for PaySpan:
This is a reminder that Envolve Vision pays claims by Date of Service and not Date of Claim Received. If you wait to bill Envolve, your payment could be delayed.
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.
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.