Please remember beginning Jan. 1, 2022, Envolve Dental will have three national product groups:
As Envolve continues to expand, your current and prospective patients may have questions about your participation in these health plans. It is important to realize how this change may affect you.
In January 2022, Wellcare will launch as the new face of Centene’s merged Medicare plans, joining Allwell, Fidelis Care, Health Net, ‘Ohana, Trillium Advantage and Wellcare. As a unified national brand, Wellcare focuses on giving today’s and tomorrow’s Medicare members the coverage they need, the simplicity they want, and the high-quality care they deserve. Envolve will administer the vision benefit under Wellcare, offering supplemental benefits beyond traditional Medicare coverage.
Ascension Complete is a Medicare Advantage plan that doctors took an active role in designing. This network of providers came together from one of the nation’s leading non-profit health systems, Ascension, and is backed by Centene Corporation, a global healthcare leader. Together they are committed to delivering compassionate and personalized care to individuals and communities. Envolve will continue administering vision benefits to Ascension Complete members in 2022.
Ambetter offers plans on the Health Insurance Marketplace in various states across the nation. Ambetter believes quality care is best delivered on a local level, partnering with local providers to provide access to the care they need. Envolve will continue to administer the comprehensive dental benefit under the Health Insurance Marketplace for 2022.
If you have any questions, please feel free to ask Envolve Customer Service.
Register to receive electronic payments from Envolve Vision! To begin receiving electronic payments from Envolve Vision, please register with PaySpan by following these instructions below:
In order to provide culturally competent and proficient medical services, providers must ensure patients have access to medical interpreters, signers and TTY services. Any services provided to facilitate communication are at no charge to the patient. If you need TTY services for a patient, call (844) 257-4142.
Are you concerned an eye doctor is inappropriately billing Envolve Vision? Do you think a member may be receiving unnecessary services? If so, please call our Fraud, Waste and Abuse Hotline at (800) 361-9025. Envolve Vision takes all reports of potential fraud, waste and abuse seriously and investigates all reported issues.
Important reminders and notices are posted on the home page of the Eye Health Manager and communicated to doctors via fax, mail, or email. To ensure you receive all email communications, please visit our homepage at the link below and select Update Email Address. In the comments section, provide your most recent fax number if applicable.
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 call Customer Service.
Envolve Vision Plan Specifics are available on Eye Health Manager. For your convenience, Envolve Vision stores all plan specifics on our website via Eye Health Manager at envolvevision.com/logon.
Plan specifics outline the following for all of the health plans we administer vision benefits for:
Envolve Vision is committed to improving the health of our community by helping people with diabetes lead healthier lives. Vision is a vital part of diabetic care. Therefore, we are asking for your help ensuring our diabetic members are receiving both preventive and ongoing quality eye care.
Current Procedural Terminology (CPT) II tracking codes can be used to measure performance. Category II codes reduce the need for record abstraction and chart review, which in turn reduces workload for physicians and staff.
To help us identify those patients who are compliant with their diabetic retinal evaluations, please remember to report the following with claims:
Please note 3072F corresponds to the result of a test performed during the year prior to the measurement period and not the present year. For tests performed in the current year, please report 2022F–2033F when applicable.
| 2022F | Dilated retinal eye exam with interpretation by an ophthalmologist or optometrist documented and reviewed; with evidence of retinopathy |
| 2023F | Dilated retinal eye exam with interpretation by an ophthalmologist or optometrist documented and reviewed; without evidence of retinopathy |
| 2024F | 7 standard field stereoscopic retinal photos with interpretation by an ophthalmologist or optometrist documented and reviewed; with evidence of retinopathy |
| 2025F | 7 standard field stereoscopic retinal photos with interpretation by an ophthalmologist or optometrist documented and reviewed; without evidence of retinopathy |
| 2026F | Eye imaging validated to match diagnosis from 7 standard field stereoscopic retinal photos results documented and reviewed; with evidence of retinopathy |
| 2033F | Eye imaging validated to match diagnosis from 7 standard field stereoscopic retinal photos results documented and reviewed; without evidence of retinopathy |
| 3072F | Low risk for retinopathy (no evidence of retinopathy in the prior year) |
The following access to care standards for appointment wait times have been established for eye doctors by our Quality Improvement Committee:
Envolve Vision’s clinical criteria, provider manuals, policies and procedures are available by logging into Eye Health Manager. Once logged in, clinical policies are located under Provider Resources, Policies and Procedures, Utilization Management. Important reminders, notices, plan specifics, and provider manuals can be found in the Providers and Provider Resources tabs. These are communicated to providers via fax, mail, or email. Clinical policies are reviewed quarterly and updated as needed.
Ensuring patients mask up is a wise move in any medical practice. However, providers may not charge Medicaid and Medicare members for services that include fees to cover the costs of personal protective equipment (PPE) such as infection control fee, biohazard fee, miscellaneous fee, etc.
PPE should be considered content of service. No existing policies allow these members to be charged an additional fee for PPE.
Providers may not bill Medicaid and Medicare members directly for any services with or without a signed form.
If your practice is charging patients for PPE, it is imperative you stop immediately. You are also required to identify Medicaid patients who may have previously been charged for PPE and dispense refunds.
Please contact your state Customer Service representative with any questions.
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.
