Coordination of Benefits

Hello. Welcome to Filing a Vision Claim – VSP Coordination of Benefits. Did you know that you can coordinate benefits between multiple VSP plans? Did you know that you can coordinate benefits between a medical insurance and VSP? There are many scenarios you may come across where you have the ability to coordinate benefits. This is a huge benefit for your practice and also a great benefit to your patient.

Let’s review the scenarios. Say we have a patient who comes in for their routine exam and is also seen for a medical eye issue. The provider determines that the chief complaint is medical. And your refraction is performed with both a medical and a routine diagnosis. You can bill the patient’s health plan and coordinate your VSP benefits by filing a secondary claim online.

Other scenarios would be the patient has two VSP plans and you would coordinate between the two. For that situation, you would need to determine the primary and secondary plan and that information can be found within the VSP manual. One thing you always want to check, of course, is your patient's authorization. Some plans have specific client exceptions that do not allow for a coordination of benefits. If coordination of benefits is not allowed, you'll find that on their authorization. To file the coordination of benefits claim you will proceed with, of course, following your standard exam filing process.

So your date of service, your attestation, select your exam type and your refraction, yes or no to whether or not the dilation was performed, apply any health conditions, and document PCP communication, whether it's completed or planned. Now for your diagnoses, if we're coordinating between a health plan and your VSP, you will of course most likely have a healthcare diagnosis. Then, you'll want to ensure to enter your patient's information and verify your insured information.

If coordinating between two VSP plans, you will enter the secondary authorization number in the green box here. If coordinating with your health plan, rather than adding, of course, a second authorization number, you would want to select yes in section 11D. This will take you to another screen where you will enter your patient's name or your insured’s name, your health insurance identification number, and the health insurance plan name.

For a coordination of benefits claim, additional claim information is, of course, required in box 19. When filing between the health plan and VSP, you will need to enter the patient's responsibility in this section. You can do this by referring to the patient's health care explanation of benefits. You will see your patient's date of service, the procedure codes, the descriptions of the procedures, your amount billed, as well as the amount allowed by the insurance. Here you will see the plan paid $71.54 and your patient’s responsibility is $55. In box 19, you will see that we entered secondary COB claim, patient responsible exam $55. Once your information is 100% accurate and complete within your claim, you would then select “Calculate HCPCS.”

Here you will see our claim form and it's very important that in the diagnosis column you change that diagnosis pointer to B, referring to the refractive diagnosis. You’ll verify or enter your charges from your usual and customary and you will enter the insurance paid amount in the paid box of $71.54. Once again, once you verified that everything is accurate and complete, you would then click “Submit” to file your claim.

Congratulations! You just filed a VSP claim.