Starting Jan. 1, 2021, Envolve Vision will add new plans across the country.
*Pediatric only
CMS requires that all managed care network providers are screened and enrolled with the applicable state(s) to receive payment for Medicaid services. This federal requirement applies to all provider types and specialties, and specifically requires both your rendering and billing NPI be appropriately registered.
In addition, billing providers must include the referring, ordering, prescribing, or attending practitioner’s name and individual NPI, as well as the referring, ordering, prescribing, or attending practitioners, NPI taxonomy or state Medicaid ID, in the appropriate claim field(s), most commonly for vision hardware.
Failure to take action may result in the suspension of payments. Our Provider Services team can help validate your information. If you have questions or want to confirm your information, please call our Customer Service department.
Find general information about Medicaid registration and specific information for select states at envolvevision.com/notice.
If you haven’t signed up for Envolve Vision’s web portal, Eye Health Manager, visit:
Get access to everything you need in one place: eligibility, claims, provider manuals, plan specifications, clinical policies, and more.
The Envolve Vision clinical criteria, Provider Manuals, policies, and procedures are available by logging into the Eye Health Manager. Important reminders, notices, plan specifics, and provider manuals are located in the Provider Resources tab and communicated to providers via fax, mail, or email. To see the most recent vision clinical policies, log in to the PWP at envolvevision.com/logon. Choose Provider Resources from the dropdown menu on the left, then Policies and Procedures, and Utilization Management.
Plan Specs are the best place to quickly understand member benefits at a glance. They are easily found online in Eye Health Manager. Log in to the portal at envolvevision.com/logon. Choose Provider Resources from the left-hand navigation, then Office Manuals for links to both Provider Manuals and Plan Specifics.
As a reminder, referrals from a primary care physician (PCP) are NOT required for a member to schedule an eye exam with any participating optometrist or ophthalmologist. Should you have any questions, please contact our Customer Service team.
Envolve Vision has partnered with PaySpan Health to deliver Electronic Funds Transfers (EFTs), Electronic Remittance Advice (ERAs). PaySpan Health is a free solution to enable online presentment of remittance/vouchers, straightforward reconciliation of payments to empower providers to reduce costs, speed secondary billings, improve cash flow, and help the environment by reducing paper usage.
How to Register for PaySpan:
In order to provide culturally competent and proficient medical services, providers must ensure that members have access to medical interpreters, signers, and TTY services. Any services provided to facilitate communication are at no charge to the member.
If you need TTY services for a member, call
This is a reminder that Envolve Vision pays claims by Date of Service and not Date of Claim Received. If you wait to bill Envolve, your payment may be delayed.
We have extended the dates of service for prior authorization requirements related to telehealth. The lifting of prior authorization requirements for telehealth services will continue through at least Jan. 21, 2021. We will keep you informed of additional changes if they become necessary.
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.
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.
