Calculating Patient Fees and Doctor Reimbursements

The VSP backend service that AcuityLogic uses to estimate patient out-of-pocket expenses and doctor reimbursements has been updated. Changes include the following:

  • Frame reimbursement amounts are more accurate.
  • Reimbursement amounts are calculated for lens material or style items instead of the base lens.
  • In claims:
    • The base lens is now a nonreceivable line item instead of a ready-to-bill line item.
    • Amounts from the new calculations are better aligned with amounts shown in the explanation of payment.

Patient out-of-pocket and doctor reimbursement calculations require the following:

  • The provider must be associated with the practice location in AcuityLogic.
  • A service code must accompany all material orders.
  • V2100 must be billed for a fee greater than zero.

The following table shows VSP plans supported by the updated backend service:

Benefit Category

Plan Name

Patient Out-Of-Pocket Estimates

Doctor Reimbursement Estimates

Full-Service Plans

Advantage

Solid check mark

Solid check mark

Signature

Solid check mark

Solid check mark

Signature Choice

Solid check mark

Solid check mark

VSP Elements

Solid check mark

Solid check mark

VSP Essentials Plan

Solid check mark

Solid check mark

Exam and Discount Plans

Access Indemnity

Solid check mark

Solid check mark

Exam Only

Solid check mark

Solid check mark

Exam Plus with Allowance

Solid check mark

Solid check mark

VSP Vision Savings Pass

Solid check mark

Solid check mark

Supplement Plans

Additional Pair

Solid check mark

Solid check mark

Additional Pair*

Solid check mark

Solid check mark

Additional Pair 2*

Solid check mark

Solid check mark

Computer Vision Care Plan*

Solid check mark

Solid check mark

Covered Contact Lenses

Solid check mark

Solid check mark

ProTec Safety Plan

Solid check mark

Solid check mark

Repair Replace*

Solid check mark

Solid check mark

Safety Eyecare

Solid check mark

Solid check mark

Safety Eyecare Supplemental

Solid check mark

Solid check mark

Safety Repair Replace*

Solid check mark

Solid check mark

Total Contact Lenses*

Solid check mark

Solid check mark

Second Pair Safety

   

* Newly supported plans

Unsupported Conditions

Due to the complexities of some products and services, the following unsupported conditions will not generate correct estimates:

  • Out-of-network (non-VSP) providers
  • Lens enhancements with multiple V- or X-codes
  • Coordination-of-benefits (COB) claims
  • Claims with V24xx, V2781, or V2799 codes