EyeMed Exam and Medically Necessary Contact Lenses

Welcome back! Next, we’re going to review information about how to file a Medically Necessary Contact Lens benefit for EyeMed. Whenever you find you have EyeMed questions, refer to the provider manual located on the EyeMed InFocus website. This is where you can find, well, everything related to EyeMed.

To find the specific instructions for medically necessary contact lenses, hover over the How-To and select the link. To file this claim, you will need to send your claim form in by utilizing the downloadable PDF form within this page to fill in and print your claim information.

Before typing or writing all of this information, verify the patient is eligible for benefits and meets the requirements to qualify. Then complete the form in full.

Start with entering your patient information: last name, first name, middle initial, your address, city, state, zip, date of birth, followed by the phone number and relationship to the subscriber. Then include the date of service, the group name, the group number, followed by the patient member ID.

Then you will complete your subscriber information (if different from your patient information).

Now prior to submitting this claim, you must absolutely ensure that you have filled in the provider information as well, including a provider signature.

Now, before reviewing the entire claim form, once again, we need to ensure that the patient meets the requirements and qualifications for the benefits available. You can see the qualifications and requirements, here is where you will want to select which qualifications the patient meets and you’ll enter the retail price for the services and materials. Now, it’s important to note that you must also file your EyeMed exam benefit online. So, this benefit specifically covers the contact lens evaluation, fit and follow-up, and materials, but not the initial exam itself.

Once the form has been completed, you will send it to the address on the first page of the claim form and make a note on your patient’s account to follow up.

Congratulations! You’ve submitted or completed a Medically Necessary Claim Form!