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