Federal regulations 42 CFR 431.107 (b) and 455.410 (b) require the State Medicaid Agency (PRMP) to enroll providers participating in Government Health Plans. This includes all providers that order, prescribe, refer, provide and bill services.
Find your practice type and review the checklist to help determine what you will need to submit.
Register as a Medicaid provider so you can access these features:
Do you have questions about how to enroll? Learn more in the FAQ.
2021 Annual Provider Training has been sent and is due by 10/1/2021. Please check your company email inbox for these important annual training materials.
Individual attestation is required each year per the Centers for Medicare & Medicaid Services (CMS). If you have any questions on how to properly perform the attestation, or if you have not received this important email from Envolve Vision of Puerto Rico, please call Envolve Vision of Puerto Rico Customer Service at (800) 531-2818.
Be sure to add firstname.lastname@example.org to your safe senders list. Check your spam filter or junk folder if you have not received this training information from Envolve Vision.
Notice is required to be sent to Envolve, in writing, for actions such as retirement, leaving network area, or termination of contract with Envolve. Providers may send written notice to:
Envolve Vision Benefits of Puerto Rico
P O Box 7548
Rocky Mount, NC 27804
Per the Envolve Vision of PR PPA, Sec 3, C.:
III. Term, Termination and Cancellation
C. Without Cause. Either party may cancel this Agreement , including any individual Plan Fee Schedule, at any time without cause upon sixty (60) days prior written notice, or as required by local, state and federal laws. Upon receipt of the sixty (60) day written cancellation notice, You may request cancellation of this Agreement in less than sixty (60) days if We are not financially impaired or insolvent. Non-payment for goods or services rendered by You is not a valid reason for avoiding the sixty (60) day advance notice of cancellation. Termination of You as referenced in this section and section B above will be subject to compliance with the Patient Bills of Rights, if applicable.
Register to receive electronic payments from Envolve Vision! To begin receiving electronic payments from Envolve Vision, please register with PaySpan by following these instructions below:
Are you concerned an eye doctor is inappropriately billing Envolve Vision? Do you think a member may be receiving unnecessary services? If so, please call our Fraud, Waste and Abuse Hotline at (800) 361-9025. Envolve Vision takes all reports of potential fraud, waste and abuse seriously and investigates all reported issues.
In order to provide culturally competent and proficient medical services, providers must ensure patients 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 (844) 257-4142.
Important reminders and notices are posted on the home page of the Eye Health Manager and communicated to doctors via fax, mail, or email. To ensure you receive all email communications, please visit our homepage at the link below and select Update Email Address. In the comments section, provide your most recent fax number if applicable. Visit envolvevision.com/logon.
Envolve Vision is committed to improving the health of our community by helping people with diabetes lead healthier lives. Vision is a vital part of diabetic care. Therefore, we are asking for your help ensuring our diabetic members are receiving both preventive and ongoing quality eye care.
Current Procedural Terminology (CPT) II tracking codes can be used to measure performance. Category II codes reduce the need for record abstraction and chart review, which in turn reduces workload for physicians and staff.
To help us identify those patients who are compliant with their diabetic retinal evaluations, please remember to report the following with claims:
Please note 3072F corresponds to the result of a test performed during the year prior to the measurement period and not the present year. For tests performed in the current year, please report 2022F–2033F when applicable.
|2022F||Dilated retinal eye exam with interpretation by an ophthalmologist or optometrist documented and reviewed; with evidence of retinopathy|
|2023F||Dilated retinal eye exam with interpretation by an ophthalmologist or optometrist documented and reviewed; without evidence of retinopathy|
|2024F||7 standard field stereoscopic retinal photos with interpretation by an ophthalmologist or optometrist documented and reviewed; with evidence of retinopathy|
|2025F||7 standard field stereoscopic retinal photos with interpretation by an ophthalmologist or optometrist documented and reviewed; without evidence of retinopathy|
|2026F||Eye imaging validated to match diagnosis from 7 standard field stereoscopic retinal photos results documented and reviewed; with evidence of retinopathy|
|2033F||Eye imaging validated to match diagnosis from 7 standard field stereoscopic retinal photos results documented and reviewed; without evidence of retinopathy|
|3072F||Low risk for retinopathy (no evidence of retinopathy in the prior year)|
Medicaid and Medicare members should not be billed for vision services including fees to cover the costs of Personal Protection Equipment (PPE) 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.
Please apply at cares.linkhealth.com/#/
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 call Customer Service.
The following access to care standards for appointment wait times have been established for eye doctors by our Quality Improvement Committee:
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.
Envolve Vision Proudly Serves. . .
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.