Online Health Manager Application (Show/Hide)

The Online Health Manager, which allows providers in our network to submit claims, research claims, verify the benefits for members and the ability to enter and view authorizations, is enjoying tremendous success. We have over 8,500 provider office locations. At this time, 38% of OptiCare's claims are submitted through our Web Site. Provider offices have told us:

"I wanted to write you and tell you that the Opticare Website has been the most efficient tool in submitting claims, checking claims status, and correcting denied claims that I have encountered in my 13 years in Healthcare."

"Since I have been using the website to submit claims, my AR has never been past 60 days."

"My time spent verifying benefits and filing claims has been cut in half."

"This is the only insurance company web site that provides all the information I need. Nine times out of ten with other sites a phone call is still needed after looking at their site wasting more time."

If your office is a part of the OptiCare Managed Vision, please don't miss this opportunity to sign up. Either fill out the form "Request Login for OptiCare's Online Eye Health Manager" on Forms or call 1-800-840-7032 for additional information.

If your office has any questions regarding these reminders or effective dates please contact Provider Relations at 1-800-840-7032.

OptiCare Building a National Panel (Show/Hide)

OptiCare is currently in the process of building a national panel of offices to support our expanding national coverage. If you are interested in joining our network or receiving additional information, please call Network Development at 1-800-531-2818 or Email them at netdevelop@opticare.net.

OptiCare NPI Implementation Strategy (Show/Hide)

The final rule establishing the National Provider Identifier (NPI) as the unique health identifier was adopted on May 23, 2005. The NPI is a unique 10-digit alpha/numeric value that is being assigned by the National Plan and Provider Enumeration System (NPPES), under contract with Centers for Medicare and Medicaid Services (CMS). It is accommodated in all standard transactions, does not expire, and will replace the multitude of Health Plan Provider ID numbers that a provider currently maintains.

As an organization, we plan to begin accepting your NPI in addition to your OptiCare Provider ID as of January 1, 2007. Please note you must still use your OptiCare Provider ID number when submitting claims electronically.

Opticare Managed Vision /AECC Total Vision Health Plan of Texas, Inc providers should be prepared to use the NPI exclusively for all electronic claim transmissions by the federally mandated compliance date of May 23, 2007.

For more information about the NPI number, as well as how to apply, please click on the link below.
https://nppes.cms.hhs.gov/NPPES/Welcome.do

NPI Update (Show/Hide)

By now, you may know that CMS has granted Health Plans flexibility as to when they will implement NPI, as long as it is before 5/23/2008 and the Health Plan has a contingency plan that documents their reasonable effort to achieve the target date. This means that trading partners (vendors and providers) must be able to comply with variable implementation dates rather than just one. If you participate on multiple vision plans through OptiCare/TVHP, it is possible that some plans will implement earlier than others. We have made system modifications that will enable us to report your NPI on encounter data to our contracted Health Plans in accordance with the variable implementation dates. Once a Health Plan implements, we cannot issue a payment to you for a covered member under the plan unless we have your NPI in our system.

Once we receive electronic claims from you, where you have used your NPI number in the transaction, we are updating our system to reflect your NPI as your one and only provider number.

Right now, the most important thing you can do to ensure uninterrupted claim reimbursement from OptiCare/TVHP is to make sure your NPI is registered with us today. Please call 800-334-3937 x 2239 for instructions if you have not registered your NPI with OptiCare/TVHP.

CMS has posted a new Special Edition MLN Matters article is with important information for Medicare providers and suppliers. Topics covered include: Common Enumeration Errors in NPPES, Dos and Don’ts When Reporting “Other Provider Identification Numbers” in NPPES, How to Use Your NPI When Billing Medicare Part A (Institutional) Claims to a Fiscal Intermediary (FI) or A/B MAC, How to Use Your NPI When Billing Medicare Part B (Professional) Claims to Carriers and A/B MACs, Important Reminders Regarding 835 Remittance Advice Changes Effective July 2, 2007 for DME Suppliers Submitting Claims to DME MACS Only

Please visit http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0725.pdf on the CMS website to view this article today.

Prior Notification Procedure for Medically Necessary Hardware (Show/Hide)

When medically necessary hardware is a covered benefit of a Payor, OptiCare Managed Vision (OMV)/AECC Total Vision Health Plan of Texas (TVHP) may request prior notification for some types of medically necessary hardware for Medicaid and/or CHIP members.  Please reference the applicable Plan Specifics to determine standard hardware items.

Providers are urged to provide prior notification to the Medical Management department for medically indicated hardware that does not meet the state Medicaid standards and/or the OptiCare policies and procedures.  OptiCare policies and procedures may be downloaded from this website, or may be obtained by contacting the Customer Relations department at 1-800-840-7032.

Please complete the Prior Notification Form which may be downloaded by clicking here or may be obtained by contacting the Medical Management department at 1-800-368-4345.

The approved prior notification form may be submitted to the lab with the optical order to ensure fulfillment of the medically necessary item.  Approval numbers will be assigned; however they will not be required to obtain reimbursement on services determined to be medically necessary through the prior notification process.  If required, the approval number may be submitted in the field provided on the optical order form or in the upper right corner of the order form if no field is available.

Anthem Providers Notice (Show/Hide)

ANTHEM EOB March 2008
ANTHEM FRAME EOB April 2008

For your protection, our privacy policy prevents us from responding to emails containing protected health information (specific information about you and your health care) because we cannot guarantee the security of these e-mails before they reach us. Please contact your customer service representative should you have questions or concerns regarding your eye care services.