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 |
|
|
Signature |
|
|
|
Signature Choice |
|
|
|
VSP Elements |
|
|
|
VSP Essentials Plan |
|
|
|
Exam and Discount Plans |
Access Indemnity |
|
|
Exam Only |
|
|
|
Exam Plus with Allowance |
|
|
|
VSP Vision Savings Pass |
|
|
|
Supplement Plans |
Additional Pair |
|
|
Additional Pair* |
|
|
|
Additional Pair 2* |
|
|
|
Computer Vision Care Plan* |
|
|
|
Covered Contact Lenses |
|
|
|
ProTec Safety Plan |
|
|
|
Repair Replace* |
|
|
|
Safety Eyecare |
|
|
|
Safety Eyecare Supplemental |
|
|
|
Safety Repair Replace* |
|
|
|
Total Contact Lenses* |
|
|
|
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