Member Benefits
A Free Annual Comprehensive Eye Exam includes the Exam and ________ ?
Refraction
This is how a patient receives their Prescription to order/receive eyewear.
What is the Three Digit extension for internal team transfer?
425
This Document lays out the Proper protocols for determining a Routine Vision vs Medical Visit.
Member Triage Protocols
If a Provider asks to join the network, what 2 states require approval prior to sending?
Florida and Hawaii
These two markets are not "open" and require additional research/review prior to sending contracts.
If Premier needs to Reinstate a members benefits, what form do we have the Provider fill out?
Reinstatement Request Form
In-Service: Forms
If a patient with a $300 Allowance buys a pair of Glasses for $565, how much do they owe?
$265
Patient is responsible for all cost above allowance
If an in-network Office is stating they need access to the Premier Portal, what department are you transferring to?
Configuration
What document would you locate information on how a Provider can submit electronic claims for direct data entry?
DDE Instructions
When someone calls in to verify if a Doctor is contracted for a particular plan, name 1 of 2 locations you can check to verify?
Vistar (Group and/or Practitioner Page - Plans)
or
Rate Lookup Tool
What is Premier's Payer ID?
65054
Located in the In-Service Packet
Can a member utilize their Allowance for Glasses and Contacts?
NO!
They must use towards one or the other. They are able to use their allowance towards multiple of the same kind (i.e. 2 Glasses), however they cannot use towards both.
If an office is seeking to add a new Doctor to their roster, what department AND what number on the internal transfer do we send to?
5. Credentialing
Premier claims payment is issued through?
VPAY
Should a provider ask to update "how" they are being paid, we will send them the EFT Instructions
A Member reaches the Network Queue needing to locate a Routine Vision Provider. Which Team do you warm transfer the Member to?
Member and Provider Services
Virtual Credit Card
This can be updated via the EFT Instructions/VPAY
Members are entitled to _____ free pair(s) of Post Cataract Surgery Eyeglasses per eye, per lifetime.
One
If the member has two separate cataract operations, the member cannot reserve the benefit after the first surgeryand purchase two eyeglasses/contacts after the second surgery
What is Number 2 on the Internal Transfer list?
Spanish Medical Admin
This Document
give you a quick overview of the particular Health Plan’s protocols and requirements including:
• Important Provider Services Phone Numbers
• What is covered (i.e. Medical, Routine Vision)
• When to obtain an Authorization
• How to coordinate Part B drugs administered in the office
• Claims information
This is a document we often refer Providers to keep handy
Authorizations are required for _______ Medical Services
ALL!
Office's may request an authorization thru the options below:
Online Premier Portal www.premiereyecare.net
Phone 1-800-738-1889, option 4, 2
Fax 1-800-523-3788
All Routine Vision Exams must be one of 2 CPT codes. 1 for New Patient and 1 for Established Patient. What are those 2 codes?
92004 (New) and 92014 (Established)
These are the codes we require for a Routine Vision visit/claims payment. Use of other codes like 92012 (Medical Visit) will not process as Routine Vision.
Name 2 specific types of Deluxe Contact Lens Fittings.
Toric (Astygmatism), Multifocal (Multiple-Focuses), Monovision (Dominant vs Non-Dominant)
As a Non-Spanish speaker, you receive a call and the person only speaks Spanish, are you able to assist them? How?
Unlike Medicare, where a medical diagnosis is required to be reimbursed for a comprehensive eye exam, with Devoted & Wellcare Medicare Advantage Plans, the ___________ or _________ determines whether a member is utilizing their “free” routine eye exam benefit or a medical eye visit.
reason for the visit or chief complaint
If a Provider says their Doctor is not appearing in the Dropdown menu when seeking an Authorization for a patient, what should be checked prior to further escalation?
Other Physician Search
Providers can search for a provider and after being used the first time, they will appear in the dropdown menu.
The Standard of Care must be met and all members must be offered a _______ retinal exam during the annual routine eye exam
Dilated
Premier’s Policy requires vision providers to provide an annual routine eye exam, which is a comprehensive eye health evaluation, that includes a dilated retina exam, cataract check, glaucoma check, as well as a refraction