New VSP Rules Regarding 1.74 Index
Single Vision, Panamic,Physio and Physio 360 are now available in 1.74 index and come automatically with Crizal Alize' with Clear Guard. Only the Physio 360 product is covered and reimbursed through VSP. S.V., Panamic and Physio in 1.74 have to be ordered as private invoice and then reimbursed by VSP. VSP refers to this as a Special Lens Procedure. Here is what they say on their web site about this proceedure.
"Explanation of Special Lenses Procedure
As new products are introduced, some are not available through the VSP options system and require special processing. While certain products are not reimbursable through VSP, VSP may approve selected products for a special lens reimbursement. These products are ordered on a private basis and require post authorization. VSP will pay an allowance toward the cost of these lenses according to the patient's prescription.
The doctor will order the product on your private invoice. If the doctor sends the Post Authorization Request Form and/or invoice form to your laboratory, return it promptly to the doctor; do not write any information on the invoice form. Bill the doctor according to your private prices. The doctor will pay your laboratory invoice and charge the patient the difference between the allowance and the usual and customary charges for the lenses.
Special Lenses Procedure on Eyefinity
Special lenses that require post authorization can be ordered through Eyefinity:
The provider will select the vision type (single vision, bifocal, etc.) and the material type (plastic, glass, etc.) in the pull-down menu.
If a lens is not listed in the pull-down menu, the provider will select "Other (Indicate Lens Not Listed) - Other" as the lens choice.
The provider will then enter the lens product name in the Lens Not Listed box and will also list the product in the Lab Special Instructions box and will type "private invoice must be used".
The provider will type "Spcl Lens-Post Auth-$xxx.xx" (cost of the lenses from your private invoice) and will list the product in Box 19 on the CMS-1500 screen.
Bill the doctor on your private invoice. The provider will submit a Post Authorization, a copy of the patient's claim form and your private invoice to VSP for reimbursement.
For the most current lens information and to determine if a product is an approved special lens, please check the Product Index in the On-Line Reference Manual. If a particular lens is not listed in the On-Line Reference Manual, call (916) 851-4900 for additional information."
"Explanation of Special Lenses Procedure
As new products are introduced, some are not available through the VSP options system and require special processing. While certain products are not reimbursable through VSP, VSP may approve selected products for a special lens reimbursement. These products are ordered on a private basis and require post authorization. VSP will pay an allowance toward the cost of these lenses according to the patient's prescription.
The doctor will order the product on your private invoice. If the doctor sends the Post Authorization Request Form and/or invoice form to your laboratory, return it promptly to the doctor; do not write any information on the invoice form. Bill the doctor according to your private prices. The doctor will pay your laboratory invoice and charge the patient the difference between the allowance and the usual and customary charges for the lenses.
Special Lenses Procedure on Eyefinity
Special lenses that require post authorization can be ordered through Eyefinity:
The provider will select the vision type (single vision, bifocal, etc.) and the material type (plastic, glass, etc.) in the pull-down menu.
If a lens is not listed in the pull-down menu, the provider will select "Other (Indicate Lens Not Listed) - Other" as the lens choice.
The provider will then enter the lens product name in the Lens Not Listed box and will also list the product in the Lab Special Instructions box and will type "private invoice must be used".
The provider will type "Spcl Lens-Post Auth-$xxx.xx" (cost of the lenses from your private invoice) and will list the product in Box 19 on the CMS-1500 screen.
Bill the doctor on your private invoice. The provider will submit a Post Authorization, a copy of the patient's claim form and your private invoice to VSP for reimbursement.
For the most current lens information and to determine if a product is an approved special lens, please check the Product Index in the On-Line Reference Manual. If a particular lens is not listed in the On-Line Reference Manual, call (916) 851-4900 for additional information."
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