Next, we’re going to go ahead and do a few examples for checking vision benefits and eligibility using VSP and EyeMed for training purposes. For VSP we will go to eyefinity.com and enter our login with our practice’s username and password.  

You can utilize either the tabs at the top of the page or the tabs at the bottom here and we would select get authorizations and check eligibility for the purposes of checking our patients' benefits. You will click here and that will bring you to a page where you can either enter your authorization that you have already retrieved or check member eligibility, which is what I have selected.  

Here you will enter your member information, which is the primary member of the plan (which is not necessarily your patient) and you enter the first name, last name, date of birth, and the last four of their social or we will enter their full ID number. The as of date will be your date of service and you will want to enter it here. Once you select search to find the member benefits, you will select on the member below.  

Now for our example, I had already retrieved an authorization but had I not, this screen would look a little different. Since I did retrieve one, we’ll go ahead and say you can select that one and click retrieve to take a look at the authorization that I've already pulled. You would just want to ensure that the date of service is prior to the expiration date.  

Now if I hadn’t pulled benefits, you would see the view coverage summary and authorize. You will see your member's name as well as any dependents, so spouse and children located underneath. Once again, you will always want to make sure to verify that you select the correct patient. With this specific plan, this patient has a member and family plan. If you don't see a patient listed here, but you know that the patient is a child or a spouse, you can attempt to add the patient by entering the last name, first name, relationship, and date of birth here. If it allows you to, it will go ahead and authorize the plan for you. If it doesn't allow you to add it will give you instructions to advise your patient to reach out to their HR or to contact VSP directly.  

Once you've selected your patient, you will be able to see which benefits your patient is eligible for. You can see that this patient is eligible for all services. Now, we can either select all services and authorize benefits or we can select the exam separate from materials. If you see a separate benefit for contact lens services, you will want to select the exam and contact lens services for one of your benefit authorizations and select your materials on a second, separate authorization.  

Understand how your practice prefers to have authorizations retrieved but for the sake of this training, we will select all services and we authorized benefits. This brings us to our patient records report.

Now on the top of this page, you will see multiple tabs here that will be utilized throughout the course of the patient eligibility and the claim filing process.  

You will want to print the patient record report or import this page into your practice management software. You will also want to print lens enhancement charges. On the patient record report, you will see your patient’s name, your member’s name, and your patient's date of birth. I know I’ve been repetitive in this next statement but always verify you have the correct authorization for the correct patient.

Then you will review your patient coverage and eligibility information. Now at the point that you notice one of your benefits are not available, you’ll want to highlight that information, that way your entire team understands what's going on, and you also want to reach out to your patient to let them know just in case they choose to reschedule to when they are fully eligible for their benefits. This at least gives them the option.   

On this plan specifically, you'll see coordination of benefits information, which we will get into more detail later on within another program. However, this plan specifically tells us that a coordination of benefits isn’t allowed. Then we go into our plan details, you will see the plan copays. We have our exam copay, a lens frame and contact lens copay. Below we have an allowance for contact lens benefits and a 20% savings on any frame overages.  

For contacts, we have the exam and contact lens exam allowance available here. If criteria was met, this patient would also be eligible for a medically necessary contact lens benefit with a $0 copay. Down below, lens enhancement details are listed. We have covered benefits and then we have add-ons, and those covered add-ons typically have an additional copay. And that is where our lens enhancement charges come into play. So, this page helps us to ensure that we are not overcharging our patients for add-ons when it comes to their lens materials and coatings. We've got our single vision cost and our multifocal cost here. So, just by looking at this, we have an authorization, we’ve now printed this authorization and highlighted any information on that page as well deemed necessary to make sure that our team knows what's going on with this patient when they come in.