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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.

2021 Annual Provider Training is Coming Soon

Please be on the lookout for important training documents on the following topics:

  1. 1. Fraud, Waste, & Abuse (FWA)
  2. 2. Maintenance of Certification (MOC)
  3. 3. Cultural Competency

Individual attestation is required each year per the Centers for Medicare & Medicaid Services (CMS). We will provide more information as soon as it is available.

PCP Referrals are not Required

As a reminder, referrals from a primary care physician (PCP) are not required for members to schedule eye exams with any participating optometrists or ophthalmologists for routine eye care. Should you have any questions, please call your designated Provider Customer Service line:

MMM of PR: (844) 833-1905

MCS: (855) 754-4943

Clinical Policies are Reviewed Quarterly

Envolve Vision’s clinical criteria, provider manuals, policies and procedures are available by logging into Eye Health Manager. Once logged in, clinical policies are located under Provider Resources, Policies and Procedures, Utilization Management. Important reminders, notices, plan specifics, and provider manuals can be found in the Providers and Provider Resources tabs. These are communicated to providers via fax, mail, or email. Clinical policies are reviewed quarterly and updated as needed.

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Reduce Administration with the Provider Portal

Eye Health Manager enables providers to view policies and plan specifics, submit claims, check claim status, and many more options that help you streamline your claims processes. To obtain a username and password to access Eye Health Manager, please visit the Request Access page.

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Envolve Coverage Decisions are
Based on Coverage, Appropriateness of Care

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

  • Envolve Vision’s Utilization Management decisionmaking 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.

Get Preferred Pricing with Essilor Lab

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 services 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% off the Essilor National Price List for any other items ordered. 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 list of participating Essilor Labs under the “Essilor Partnership Forms” section found in Online Forms.

Keep Your Office Hours Updated

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During the last year, your office may have had changes to office hours, including closed offices. Be sure to keep information current using one of the following methods. If your office has recently updated its hours due to COVID-19, please verify that these times are correct.

  1. MMM of PR: (844) 833-1905
    MCS: (855) 754-4943

Billing Primary Payers Before Billing Medicare Plans

20.1 - General Policy: (https://www.cms.gov/regulations-and-guidance/guidance/manuals/downloads/msp105c03.pdf)

(Rev. 123, Issued: 08-17-18, Effective: 11-20-18, Implementation: 11-20-18)

Based on the law and regulations, providers, physicians, and other suppliers are required to file claims with Medicare using billing information obtained from the beneficiary to whom the item or service is furnished. Section 1862(b)(6) of the Act, (42 USC 1395y(b)(6)), requires all entities seeking payment for any item or service furnished under Part B to complete, on the basis of information obtained from the individual to whom the item or service is furnished, the portion of the claim form relating to the availability of other health insurance. Additionally, 42 CFR 489.20(g) requires that all providers must agree “to bill other primary payers before billing Medicare.”

Thus, any providers, physicians, and other suppliers that bill Medicare for services rendered to Medicare beneficiaries must determine whether or not Medicare is the primary payer for those services. This must be accomplished by asking Medicare beneficiaries, or their representatives, questions concerning the beneficiary’s MSP status.

Vision Care by the Numbers

Envolve Vision Proudly Serves. . .


States + Puerto Rico




Medicaid Lives


Health Plans


Medicare Lives


Health Insurance Marketplace Lives

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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