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Envolve Vision is a leader in superior, tailored vision benefits and services for Medicaid, Medicare, and Marketplace member products. Every quarter we’ll share key news that you can use to best serve your patients.

Not Just Medicaid: We Cover Medicare and Exchange Members in Many States

While you may be more familiar with our partner Medicaid plans, did you know we also cover members who access vision care through these Medicare and Affordable Care Act health plans?

Ambetter Logo

Affordable, comprehensive exchange plans for individuals and families who may not qualify for Medicaid or other government coverage. More than 90 percent of Ambetter members are eligible for subsidies.

map of Ambetter states: WA, NV, NM, KS, TX, MO, AR, MS, GA, FL, SC, IL, IN, OH, PA

2020 Ambetter Health Insurance Marketplace Vision Benefits*

Ambetter vision benefits for members who opt into a vision plan may include:

  • One eye exam with refraction per calendar year
  • One pair of certain ophthalmic lenses per calendar year*
    • In lieu of eyeglasses, members may elect the contact lens benefit as described in the plan specifics
  • Qualifying members age 19 and over are eligible for a $130 allowance towards eyeglass frames or contact lenses
  • Members under age 19 are eligible for an eyeglass frame covered in full or an initial supply of contact lenses; co-payments and co-insurance vary
  • Standard contact lens fitting covered in full
  • Certain medically necessary eye care services (varies by state – please consult your state Plan Specs published
    at visionbenefits.envolvehealth.com)

Allwell Logo

A Medicare Advantage plan that debuted in 2018 for seniors and those with disabilities, offering the quality healthcare you’d expect from a big company, but delivered on a local level.

map of Ambetter states: NV, NM, KS, TX, MO, AR, MS, GA, FL, SC, IL, IN, OH, PA, WI

2020 Allwell Medicare Vision Benefits* May Include:

  • One eye exam with refraction every calendar year
  • Retail eyewear allowance each calendar year
    • May be used towards the purchase of glasses (including lens add-ons or upgrades) and/or the purchase of contact lenses and fitting fees
    • Members are responsible for any amount over the allowance
  • Optical services that are medically necessary and meet Envolve Vision clinical policy guidelines
  • Copayments and coinsurance may vary

Ascension Logo

Launched in 2020, this Medicare Advantage plan is shaped by Ascension doctors, who work for one of the country’s largest non-profit Catholic health systems. Ascension Complete provides Medicare recipients with a more personalized care experience. With a legacy of providing compassionate care that goes back centuries, Ascension Complete isn’t just a new Medicare Advantage plan — it’s the only one of its kind.

map of Ambetter states: WA, NV, NM, KS, TX, MO, AR, MS, GA, FL, SC, IL, IN, OH, PA

2020 Ascension Complete Medicare Vision Benefits* May Include:

  • One eye exam with refraction every calendar year
  • Retail eyewear allowance each calendar year
    • May be used towards the purchase of glasses (including lens add-ons or upgrades) and/or the purchase of contact lenses and fitting fees
    • Members are responsible for any amount over the allowance
  • Optical services that are medically necessary and meet Envolve Vision clinical policy guidelines
  • Copayments and coinsurance may vary

*See each state’s plan specifics posted on Eye Health Manager for more details.

Additional Supported Marketplace and Medicare Advantage Health Plans

Envolve also supports membership for other leading health plans around the US to include:

  • Community Health Choice (TX – Marketplace and Medicare Advantage)
  • MMM of Florida (Medicare Advantage)
  • Trillium Community Health Plan (OR – Medicare Advantage)
  • UPMC Health Plan (PA – Medicare Advantage)
  • Sendero Health Plans (TX – Marketplace)
  • MMM (PR – Medicare Advantage)
  • MCS (PR – Medicare Advantage)

For information about contracting for additional products with
Envolve, please contact us at envolvevision.com/join.

Billing for PPE

Medicaid and Medicare members should not be billed for services including fees to cover the costs of Personal Protection Equipment (PPE) such as infection control fee, biohazard fee, miscellaneous fee, etc.

Vision Care by the Numbers

Envolve Vision Proudly Serves

25

States + Puerto Rico

22,000

Providers

9,200,000

Medicaid Lives

37

Health Plans

840,000

Medicare Lives

2,100,000

Health Insurance Marketplace Lives

Have a Fraud, Waste, or Abuse Concern?

Just like you, Envolve Vision takes the detection, investigation, and prosecution of fraud, waste, and abuse seriously. We perform ongoing claims audits that in some cases may result in taking actions against those providers who, individually or as a practice, commit fraud, waste, or abuse. We make it easier for you to report any fraud-related concerns with a new email address that connects you directly with our Special Investigation Unit (SIU). This new mailbox will be used for fraud-related referrals, SIU inquiries, and provider correspondence.

Please use EBOSIU@envolvehealth.com going forward to make sure your concerns are handled as quickly as possible.

Dentist with a face mask and face screen

Essilor Labs Offers Preferred Pricing

Did you know that as a valued Envolve Vision provider you get preferred pricing from Essilor Labs? Through our mutual partnership arrangement, Envolve Vision providers have full access to excellent laboratory service backed by Essilor’s commitment to meet your needs and help you grow your practice. When you use an Essilor Lab, you will receive low, fixed pricing on many standard lenses, materials, and upgrades. You are also entitled to 32-percent off the Essilor National Price List for any other items ordered. In order to receive the discount, please be sure to:

  • Select Envolve Vision on your order online; or
  • Notate “Envolve Vision” on your fax order form in the special instructions box; or
  • Inform the customer service representative that it is an Envolve Vision order.

See the list of participating Essilor Labs under the “Essilor Partnership Forms” section found at visionbenefits.envolvehealth.com/forms.aspx.

Diabetic Retinopathy Screening

Envolve Vision is committed to improving member eye health. People with diabetes are at risk for developing retinopathy. Diabetic retinopathy remains the leading cause of blindness among working-age U.S. adults – even though timely screening and treatment may prevent up to 90 percent of blindness. Screening for retinopathy allows for early detection and management to reduce the risk of vision loss. In support of this commitment, here are some ways our providers can help:

  • Reach out to established patients who have not had a diabetic retinal screening.
  • Help patients schedule an appointment to see an eye care professional.
  • Make reminder calls or mail reminder postcards to patients who have appointments to decrease no-show rates.
  • As a reminder, 3072F or other informational CPT codes should be included to indicate no evidence of diabetic retinopathy in the prior year, when applicable.
  • This code may be separately reimbursable. Please refer to your plan specs and fee schedule.
  • Additionally, it is important to communicate the findings of the screening to the member’s primary care provider to ensure proper care coordination in preventive care.

Thank you for all that you do to make member health a priority!

Dentist with a face mask and face screen

Our Utilization Management Guidelines

As part of our ongoing commitment to our members and providers, we would like to affirm the following:

  • Envolve Vision Utilization Management decisionmaking is based only on appropriateness of care and service and existence of coverage.
  • Envolve Vision does not specifically reward practitioners or other individuals for issuing denials of coverage.
  • Financial incentives for Utilization Management decision-makers do not encourage decisions that result in underutilization.

Be Sure to Review Clinical Policies Before Completing Services

Envolve Vision clinical criteria, policies and procedures are available by logging into Eye Health Manager at visionbenefits.envolvehealth.com/logon.aspx. From the Provider Resources drop-down, select Policies and Procedures, and then Utilization Management.

If you do not have access to Eye Health Manager, register for access at envolvevision.com/requestaccess.

About Envolve Vision

For more than 30 years, Envolve Vision has partnered with vision care providers across the country to administer eye care programs that meet the needs of their members. You are among 22,000+ unique eye care providers, including independent providers and popular retail chains, within our network. Thank you for partnering with us to provide quality vision services to your patients.

Envolve Vision Benefits Logo