When Health Maintenance Organizations first began carving out segments of their benefit coverage to ancillary groups specializing in specific areas of care, those organizations could ride on the regulatory coattails of the delegating HMO. Single specialty providers, in many cases, must now be licensed or accredited in their own right, in addition to being subject to audits by delegating HMOs.

Some states require that we be licensed as a single specialty HMO, others as a Third Party Administrator, while still others require reporting under their PPO (Preferred Provider Organization) or IPA (Independent Practice Association) guidelines. OptiCare is experienced in successfully applying for and obtaining the necessary licensures or designations that are required in each market that we serve.

As one of the nation's largest providers of medical surgical eye care administration, we are often required to be accredited as a Utilization Review Agent. This process varies from state to state; however, OptiCare has all of the appropriate policies, procedures and documentation in place. We have been successful in obtaining Utilization Review Agent status each and every time we have made application.

OptiCare follows Center for Medicare and Medicaid Services (CMS) national policy guidelines, National Correct Coding Initiative (NCCI) Edits, Local Carrier Determinations (LCD), The American Academy of Ophthalmology (AAO) Preferred Practice Patterns, and The National Committee on Quality Assurance (NCQA) guidelines. We routinely undergo rigorous audit reviews by the health plans with whom we contract and we welcome onsite inspection of our operations.