VSP Exam and Medically Necessary Contact Lenses

Next, we’ll review how to submit a claim for an exam and medically necessary contact lenses. You’ll enter your authorization number and once you’ve pulled up the authorization or claim form, you’ll begin to enter your patient’s exam information. You’ll also start to file this claim as if you are filing your other contact lens benefits, but within your contact lens reason, we’re going to select the necessary contact lenses. 

You’ll enter your material type, your services, followed by your manufacturer and lens brand. You want to enter the number of lenses in a box and contact lens modality. You’ll enter your patient’s diagnosis and ensure that your patient insured information is correct. Next, your physician and account number as well as your servicing facility information and any additional claim information here. For this patient I know that they qualified due to a high myopia power, so you must click “Continue” and enter their prescription, prior to calculating and continuing forward. If your patient passed the VSP diagnostic criteria, you’ll see this drop-down. If your patient did not pass, you will see that this patient is not eligible. 

Once your patient has passed, you’ll begin to enter your usual and customary fees, followed by the patient-paid amount. It’s extremely important to understand the qualifications in the diagnosis or conditions required to meet the medically necessary contact lens benefit requirements. You can do this by looking at the VSP provider manual to help you better understand what qualifies your patient for a medically necessary contact lens benefit. Once you’ve entered your information, of course, click “Submit.” 

Congratulations! You just filed a VSP claim.