Modifying Methods for Non-Formulary Contact Lenses

Eyefinity recommends that you modify your insurance schedules to address the contact lens coverage updates being implemented by OptumHealth Vision (Spectera) for all contact lenses. For nonformulary contact lenses, Eyefinity recommends that you modify the methods used to address the fitting fee coverage update. If you have questions or concerns about modifying insurance schedules, contact Eyefinity support before you make any changes.

  • If you have not yet received the details of the contact lens coverage updates from OptumHealth Vision (Spectera), contact your OptumHealth Vision (Spectera) customer service representative.
  • Due to the updates being implemented by OptumHealth Vision (Spectera), the insurance receivables for contact lenses will be incorrect. You may need to make adjustments to your receivables in AcuityLogic Billing.
  • For multitenant environments, the following setup can be performed only by administrators of the parent company. Setup and updates for individual companies can be performed after the initial setup is completed. See Setting Up Insurance for Individual Companies.

To modify methods for nonformulary contact lenses

  1. In AcuityLogic Admin, click Insurance and select Plan.

    The Insurance Plan window opens.

  2. Select or type OptumHealth Vision (Spectera) in the Carrier Name field.
  3. Select or type the name of the OptumHealth Vision (Spectera) insurance plan you want to update in the Plan Name field and click Find.
  4. Click the Expand icon to display the insurance schedules for the plan.
  5. Click the link for the insurance schedule you want to update in the Schedule Name column.

    The Insurance Schedule window opens.

  6. Select Contact Lens in the Item Type drop-down list.
  7. Click the link for a nonformulary contact lens in the Item Name column.
    In your insurance schedules, you can identify formulary contact lenses by their style name. To identify nonformulary contact lenses, look for the items in your insurance schedules that match the “Disposable” contact lens item group name.

    The Edit Schedule Item window opens for the item.

  8. Type 0 in the Covered Fitting Fees field to ensure AcuityLogic POS users collect the contact lens fitting fees for nonformulary contact lenses.
    Setting the covered fitting fee to $0 applies the entire allowance to the nonformulary contact lenses.
  9. Select Disposable in the Covered CL Type field, if needed.
  10. Select Call in the Allowance Type field.
  11. Click Save.
  12. Click Save & Return to save the insurance schedule.

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