Configuring Spectera Formulary Contact Lens Allowances

You can configure contact lens coverage allowances for Spectera insurance plans. From the Formulary Contact Lens Allowances window, you can perform the following actions:

  • Add contact lens allowance amounts along with the corresponding quantity of disposable and planned replacement boxes allowed. You can add contact lens coverage allowances that apply to all plans or to specific plans.
  • Edit the quantity of disposable and planned replacement boxes allowed for an allowance amount.
  • Copy contact lens coverage allowances between plans.
  • View a history of all changes made to contact lens coverage allowances.
  • Generate a PDF report showing contact lens coverage allowances for all plans and individual plans.
  • While the following procedure can be used for any insurance carrier, this functionality is intended for setting up formulary contact lens allowances for Spectera insurance plans.
  • The contact lens coverage allowances that were previously set up for the selected company appear in the grid the first time you access the Formulary Contact Lens Allowance window.
  • For multitenant environments, the following setup must be completed for each company. The parent company setup is not automatically applied to individual companies.

This section explains how to set up contact lens coverage allowances.

Topics include the following:

  1. Open the Company Information window. See To open the Company Information window.
  2. Click the Add. Carrier Att. link for your company.

    The Company Carrier window opens.

  3. From the Insurance Carrier drop-down list, select the carrier name your company has set up for Spectera.
  4. Click the Setup link in the Formulary CL Allowance column.

    The Formulary Contact Lens Allowances window opens.

  1. Open the Formulary Contact Lens Allowances window. See To open the Formulary Contact Lens Allowances window.
  2. To search for allowances that apply to a specific plan, select the plan name from the Plan drop-down list.
    The Plan drop-down list is blank by default and the allowances that appear in the grid apply to all plans.
  3. To search for allowances that are currently inactive, select No from the Active drop-down list.
    Yes is selected in the Active drop-down list by default and the allowances that appear in the grid are active. To view both active and inactive allowances, leave the Active drop-down list blank.
  1. Open the Formulary Contact Lens Allowances window. See To open the Formulary Contact Lens Allowances window.
  2. To add an allowance for a specific plan, select the plan name from the Plan drop-down list.
    If you add an allowance with the Plan drop-down list blank, the allowance applies to all plans.
  3. Click Add.

    A second Formulary Contact Lens Allowances window opens.

  4. Enter the allowance values in the following fields:
    • Allowance: Enter the allowance amount.
    • Allowed Disposable Boxes: Enter the quantity of disposable contact lenses boxes allowed for the allowance amount.
    • Allowed Planned Replacement Boxes: Enter the quantity of planned replacement contact lenses boxes allowed for the allowance amount.
  5. (Optional) To add the allowance as inactive, deselect the Active check box. The Active check box is selected by default.
  6. Click Save.
  1. Open the Formulary Contact Lens Allowances window. See To open the Formulary Contact Lens Allowances window.
  2. (Optional) Search for the allowance to edit. See To search for contact lens coverage allowances.
  3. Click Edit in the row for the allowance you want to edit.
  4. Update the quantity of disposable or planned replacement boxes allowed in the provided fields.
  5. (Optional) Update the selection in the Active check box.
    You cannot update or delete allowance amounts. If you no longer need an allowance amount, deselect the Active check box to make it inactive.
  6. Click Update.
  1. Open the Formulary Contact Lens Allowances window. See To open the Formulary Contact Lens Allowances window.
  2. Click Copy.

    The Copy Formulary Contact Lens Allowances window opens.

  3. From the Copy from Company drop-down list, select the company with the allowances you want to copy.
  4. From the Copy to Company drop-down list, select the company you want to copy allowances to.
  5. From the Copy From Plan drop-down list, select the plan with the allowances you want to copy.
    All allowances configured for the selected plan are copied. You cannot select individual allowances to copy to another plan.
  6. From the Copy To Plan drop-down list, select the plan you want to copy allowances to.
    If the plans you are copying allowances between have the same allowance amount but different box quantities, the box quantities for the plan you are copying allowances to will be overwritten.
  7. Click Copy and click OK in the confirmation message window.
  1. Open the Formulary Contact Lens Allowances window. See To open the Formulary Contact Lens Allowances window.
  2. Click History.

    The Allowance History window opens and shows all changes made to allowances. The history includes the date and time of the change, the employee that made the change, the carrier associated with the allowance updated, the plan name associated with the allowance update if applicable, and the change made.

  1. Open the Formulary Contact Lens Allowances window. See To open the Formulary Contact Lens Allowances window.
  2. Click Generate Report.

    The CLAllowancesReport.pdf is exported to your default download folder. The exported PDF report shows the allowance details for all plans and for individual plans. The allowance amounts without a plan name apply to all plans.

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