Welcome to Assignment!
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Welcome to Luxottica Assignment! And overview of information for our Pearle Licensed Operators
Transcript of Welcome to Assignment!
Welcome to Luxottica Assignment!
And overview of information for our Pearle Licensed Operators
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What is Assignment?➢ The Luxottica Assignment (ASN) Department works with insurance carriers not affiliated with
EyeMed to drive additional sales into our retail locations as well as additional traffic to our Licensed Operators.
How does Assignment differ from EyeMed?➢ EyeMed is a Managed Vision Care company fully owned by Luxottica. Because Luxottica
“owns” these member records, EyeMed member plan benefits and eligibility information is accessible through www.eyemed.com
➢ ASN member benefits are owned and administered by other Managed Vision Care (MVC) companies, so member benefits and eligibility information is not accessible through www.eyemed.com
➢ Each MVC company has a different process for obtaining benefit information and authorizations (i.e. IVR, website, call center)
➢ ASN plans require the member/subscriber information to be entered into eyemedvisioncare.com to be included on all claims for processing
Benefits of Participating with the Assignment Department
➢ No need for individual contracts with each carrier
➢ No individual credentialing - The Assignment agreements have delegated credentialing
➢ Access to participate on more vision care plans than a stand-alone optical center or doctor’s office
➢ No requirement to use carrier’s labs or product
What is required to participate on ASN plans?
➢ Complete EyeMed’s credentialing process, ensuring all doctors at the location are credentialed thru EyeMed
➢ A Location NPI# is required for each location. This is different than an organizational or Doctor’s NPI#. Register for a location NPI# thru the NPPES NPI Registry.
➢ CAQH information for the doctors is maintained/kept up to date
Note: a location may choose to opt out of participating on the Assignment plans by emailing [email protected] to request an Opt Out form.
Assignment Relationships
1/14/2021
Avesis (includes Guardian and BCB SC) Alwaysvision – Also known as Starmount,
Unum, Alwayscare & Colonial Life
Cigna – Can be added to Luxottica’s
agreement if Provider does not contract directly with VSP. Email: [email protected] to request to be added to Luxottica’s agreement
Coast to Coast (Discount Plan) Community Eye Care Davis Vision – Participation is not with all Davis plans
Envolve – Does not include Medicaid plans
Healthpartners (Exam only) Heritage Vision
Medical Eye Services (MES) Trader Joe’s Exam Plan Administered by Blue Shield of CA only. Provider contracts directly for all other MES plans.**
Outlook Vision (Discount Plan) Physicians Eye Care
Quality Vision (Discount Plan) Superior Vision – Including Medicare Advantage Plans
UPMC – Direct (this does not include UPMC NVA or UPMC Medicaid
VBA – Provider can email [email protected] to request to be added to the Luxottica agreement. Otherwise, they can contract direct
Vision Care Advantage (Discount plan)
• All agreements are under Luxottica of America Tax ID 31-1339854• Payments come from Luxottica and not direct from the vision carrier.** - MES – Locations in CA, NV & TX would contract direct for all MES plans. Outside of those states' locations go thru us for the Trader Joe’s Exam only group.
Davis Vision – Call Outs
Listed below are plans that Davis Vision will give you an authorization for, but we are NOT participating providers. Davis is unable to remove our access to authorizations for these groups without removing us from their larger network.
Even though you are able to obtain an authorization for the groups that start with the prefixes listed below, you must inform the member you are not a participating provider as your claim will be denied.
• Carefirst Pediatric/Exchange plans - CFB, CFN, CFW, EDX, EXB, EXC, EXD
• Guardian – GLI, IUP, ZGS, ZHA, ZHB, ZHN, ZHP, ZZC (Guardian is transitioning to Avesis)
• Highmark – HQF, IUV
• Pocono Mountain School District – BPS, BSU, PMS
If you are unsure if you are a participating provider for a plan, contact our Assignment call center (877.313.1752) to see if the plan you are looking for is one that we are not participating on.
The following are Medicaid plans in PA. Licensed Operators are not included under our agreement due to state Medicaid requirements. Note: Davis cannot prevent their system from providing an authorization, but like the plans listed above, you must inform the member you are not a participating provider as your claim will be denied.
➢ Amerihealth – AHJ, AHM, AMH, KAB, KAQ
➢ Gateway Health – GH3, GH5, GH7, GHL, GHP, GHQ, GHR, GHV, GHX
➢ Health Partners/Keystone – HP5, HP6, HPC, HP1, HPK
➢ Keystone – KAC, KAE, HPI, KAF, KAG, KAM, KAK, KAA,
➢ Three Rivers CHIP & MED Plus – TRC,TRM
How to Verify Member Eligibility
Vision Carrier Membership Eligibility # Website Access Authorizations
AlwaysVision National 1-888-729-5433
https://www.alwayscarevision.com/Account automatically setup by ASN
User ID: PV4digit st #/ passcode: Vision17Target would use “TO” + 4 digit store # Authorization provided
Avesis National 1-800-952-6674
https://www.avesis.com/commercial3/providers/index.aspxPearle LO –reach out to ASN-
Providerrelation@Luxotticaretail/com to have an account setup
Authorization provided but not necessary for claim payment
Community EyeCare National 1-888-254-4290
Reach out to [email protected] to have an account setup Authorization Provided
Davis Vision National 1-800-773-2847
www.davis vision.comUser name: varies
Passcode: Cole2013Jan
Authorization required on claim. Exam/material authorization must be separate
Envolve National 1-800-840-7032 Not available N/A
HealthPartners National 1-952-883-5000Reach out to [email protected] to be
setup N/A
Heritage National 1-800-252-2053 Not available
Authorization provided . Auths for exam and materials are combined
MES (Medical Eye Services) for Trader Joe’s plan through Blue Shield of CA
National.Locations in CA, TX,& NV contract direct with MES N/A
https://www.mesvision.com/prvUser ID is MES PIN# /passcode is last 4 digits of the store
location’s phone number Authorizations required on claim
Physicians EyeCare National 1-800-368-9609 Not available Authorization provided
Superior Vision National 1-800-507-3800
www.Superiorvision.comUse location NPI to setup web access
Sublease next to corp locs – partner with the store Reference # provided
UPMC Direct PA 1-877-648-9621 Not Available N/A
Note: do not alter passcodes for website access
NOTE: Davis Guardian plans are transitioning to Avesis. If you are no longer able to verify eligibility on the Davis website, it is possible that particular Guardian group is now with Avesis.
How to submit a claim
• Claims are submitted to the ASN department via the EyeMed website, under the Assignment option.
• You must first click on “Assignment plans” when filing an Assignment claim. Failure to do so will result in the claim not being processed or payment retracted due to
missing information.
• Once you have submitted your claim, our department will do a basic review of the information and release it to the vision carrier. At the same time, we will generate a payment to you , under the tax id you have filed with EyeMed.
• In some instances, during our basic review, we may place the claim in a pended or not submitted status. When you see this, do not resubmit. Please reach out to our Assignment Call Center (877.313.1752) to determine why the claim is being held.
On the next screen you will have the option of looking for a plan by name or by a plan ID#.
You will also be entering the patients date of service.
Locating plans in the EyeMed website
Vision Carrier Plan name format Additional Call Outs
AlwaysvisionPlan names start w/ Alwaysvision., followed by “V” and member’s 3- or 4-digit group number.
Ensure member is getting contacts before submitting for contact fitting.
AvesisPlan names start w/ Avesis and are identified by additional 3- or 4-digit group numbers. Some groups are listed by a specific name
Community EyeCarePlan names start w/ “Community Eye” and are broken out by Exam, Exam & Fit, Contacts and Frame & Lens
Davis Plans are setup by Group or employer name We try to use the employer group name listed on
the Davis website
EnvolvePlans start w/ “Envolve” and are broken out by Exam, Exam & Fit, Contacts and Frame & Lens
Ensure member is getting contacts before submitting for contact fitting
HealthPartners Plans start w/ “HealthPartners” and followed by exam copay amount Exam only plan
Heritage Plans are set up by Group or employer nameEnsure member is getting contacts before
submitting for contact fitting.
MES (Trader Joe’s plan administered by Blue Shield of CA) Plan name is “Trader Joe’s (MES Exam only).
EyeMed also has membership with Trader Joe’s. The EyeMed Plan is for exam and materials.
Physicians EyeCarePlan names start w/ “Physicians Eyecare (PEP)” and are broken out by Exam, Exam & Fit, Contacts and Frame & Lens
Superior Vision
Plan names start w/ “Superior Vis”. Standard plans are setup with exams, exam/fit, contacts and F& L separately. Non-standard plans include the employer or group name, and all benefits are included under one plan.
UPMC Direct Plan names start w/ “UPMC”
Requirements for submitting an ASN claim
• Eligibility must be verified directly with the vision carrier prior to servicing the customer. EyeMed does not hold membership/eligibility.
• Patient information must match what the vision carrier has on file (Do not use nicknames)
• Ensure the correct date of birth and service date is entered
• Enter subscriber information if different than the patient/customer
• Always enter the authorization/reference # if the vision carrier provides one. (For those carriers that do not supply an auth/ref #, key in the reps first name)
• Provide the full member ID#
• When submitting for fitting, ensure the customer is not intending on getting eyeglasses. Several plans lock the member into getting contacts if a fitting is submitted.
Benefit Calculations and Call-outs
Plans are set up to automatically calculate benefits based on the member being eligible for all services. Members may not always be eligible for all services, so it is imperative to verify eligibility prior to rendering any services to the member.
• If the member is not eligible for a service, do not submit that service as part of the claim. Or you may contact the ASN Call Center and request a modification of the claim. (Note: The EyeMed website does not allow benefits to be edited. )
• Contact Benefits: Most vision carriers that we work with include the fitting as part of the contact material benefit. And most vision care plans allow the member to receive Contacts OR Frame & Lenses. If the member is requesting the fitting to be submitted to their vision carrier, make sure the member is either getting contacts OR they have a plan that considers the fitting a separate benefit from the material services.
Plans that include the fitting as part of the contact benefit:
o Alwaysvision - $35 of the contact allowance is allocated to the standard fitting. Remaining allowance amount is applied to the contact materials
o Heritage - $40 - $50 of the contact allowance is allocated to the fitting (depending on the plan). Remaining allowance amount is applied to the contact materials
o Superior Vision – for some plans the fitting is part of the contact allowance, whereas others have the fitting as a separate benefit, not affecting the material services.
As we add new groups/plans, more may be added to the list. Always verify with the carrier how the contact fitting may impact the contact material allowance services.
Payment
• After the provider finalizes and submits the claim, the claim is reviewed to ensure it is complete. If information appears to be correct, we will submit the claim to the vision carrier and payment will be issued to the provider at that time.
• If you notice a claim is in a “pended” or “not submitted” status on eyemedvisioncare.com for longer than 3-weeks, contact the ASN Call Center (877.313.1752) to identify what could be holding it up.
• If the claim is denied by the carrier, an “intent to withhold payment” letter will be sent to the provider indicating the denial. If we do not receive a response back from the provider, we will retract the initial payment.
o If you receive a withhold letter, review the denial reason on the letter. In most cases, a claim is denied if the ID, name and or authorization # is incorrect. If you can provide us with the correct information, we will resubmit the claim to the carrier.
• It is recommended that the provider submits claims daily. The EyeMed website will only allow 90 days for you to key a claim. If the date of service is older than 90 days, you will have to forward a paper claim to the ASN Department. Note: Most of the vision carriers we work with have filing limits in the 60 – 180-day range.
Contracting Directly with Vision Carriers
Some vision carriers we work with require the Licensed Operators to contract directly with them versus being included in our agreements. Listed below are some of these plans and how to contract direct.
NVA (National Vision Administrators):
o https://www.e-nva.com/nva/content/home/home.jsf
o Choose “Sitemap” at the bottom of the screen
o Under Eyecare Professionals – choose New Eyecare Professional Enrollment.
o Follow instructions provided
MES State Specific - CA, NV & TX states contract direct for all MES plans. All other states will file the Trader Joe’s exam claims administered by Blue Shield of CA under the Assignment relationship
o Submit email to: [email protected] (The EyeMed website, on their home page, may also have a link to MES for contracting direct.
o Identify yourself as a Pearle independent location
o Request a contract
Note: If you are outside of the above states and want to contract directly with MES for all lines of business, please email [email protected] so we can remove from our delegated agreement.
Contracting Direct with Vision Carriers (Cont’d)
NBN (Mainly WA):
o Call NBN direct at 1-800-732-1123 (Local: 1-206-726-2780) and indicate you are looking to contract direct.
o You will be transferred to a representative in their provider relations area
United Health Care/Spectera (National) – Pearle Licensed Operators Only:
o Submit request to : [email protected]
o Identify yourself and/or location as a Pearle Franchise
o Sublease doctors next to a corporate location would automatically be added to our agreement with Spectera. Sublease doctors would partner with the store to obtain eligibility information.
Voiding claims and/or return of services
• Claims that have not billed out (pended status, not submitted) can be voided by the provider through the EyeMed website.
• If payment has been generated, the provider will need to contact the Assignment Call Center (877.313.1752) to request the claim to be voided and payment retracted and to have member’s benefits reinstated.
• Return of services should be handled by contacting the Assignment Call Center to ensure the member’s benefits are reinstated.
Frequently Asked Questions
Q: What is the contact information for Luxottica’s Assignment Call Center and when are they available?A: You can reach the Assignment Call Center at the following number, during the hours listed below:
Phone: 1-877-313-1752Hours of Operation: Monday-Friday 8:30 am – 5:00 pm Eastern Standard Time
Q: What can the Luxottica Assignment Call Center assist with?A: The Assignment Call Center can assist with the following:
a. How to submit an Assignment claimb. Claim statusc. Payment inquiriesd. Claim void requestse. Denialsf. Corrections/adjustments to claimsg. Assistance in locating correct plans in systemh. General questions/concerns related to Assignment plans and participation
Q: What is the Luxottica of America Tax ID number?A: The Luxottica of America Tax ID is 31-139854.
Frequently Asked Questions (Cont’d)
Q: What should I do if a customer returns services on a claim already submitted?
A: Contact the ASN Call Center (877.313.1752) and request a void form.
Q: Am I able to coordinate benefits through the Assignment relationship?
A: No, under the Assignment relationship we are only able to bill the primary plan. If the member has additional coverage through a secondary vision care plan, they will need to submit directly for additional reimbursement.
Q: Does Assignment participate on Medical or Medicaid plans?
A: No, our current Assignment contracts and agreements that include Licensed Operators are strictly for routine vision coverage.
Q: What is the process for medically necessary contacts?
A: Contact the vision carrier to verify and receive pre-approval for medically necessary contacts. Then contact the ASN Call Center (877.313.1752) to receive instructions on how to submit a claim. Include any additional documentation requested by the carrier to process the claim, including all the codes and the benefit amounts.
Q: Am I required to participate on Assignment plans?
A: No, you may opt out of participating on Assignment plans. Please contact Assignment Provider Relations at [email protected] to request an opt-out form.
Notes
