Fixing VSP On-Hold Claims

When there is a problem with a VSP claim and it is placed on hold, the system returns a message describing what is wrong. Use the information in the message to correct the problem.

This topic explains where to find the messages and lists the most common messages and how to fix the associated problems.

Viewing On-Hold Claim Messages

On-hold claim messages are saved as notes in Claim History. You can access them as follows:

  1. In AcuityLogic Billing, search for a claim, selecting On Hold as the claim status and VSP as the carrier. See Searching for Claims.

    All the on-hold VSP claims in your system are displayed.

  2. View the history of a claim by using one of the following methods:
    • From the claim's Action drop-down list, select Claim History.

      The Claim History window opens.

    • In the Claim # column, click the claim's link.

      The Claim Detail window opens. The claim history appears at the bottom of the window.

  3. Click the icon in the Notes column of the Claim History table.

    The Claim Note window opens. The on-hold claim message appears in the Note area.

Common On-Hold Claim Messages

The following table lists the most common VSP on-hold claim messages. For each message, the reason the claim was put on hold and the method for fixing the issue are provided.

Message Reason How to Fix
Unable to Calculate - Cannot process the order because a previous order has already been submitted for processing. Order was placed using eyefinity.com and has been submitted. Change the claim status to Billed.
Store Login information is not set up. Unable to process claims. The VSP integration is not set up properly. Do the following:
  1. In AcuityLogic Admin, click Insurance, and select Screen Scraping Management.

    The Screen Scraping Management window opens.

  2. From the Location Name drop-down list, select your office.
  3. From the Carrier Name drop-down list, select VSP.
  4. In the VSP section, enter your office's eyefinity.com login name and password.
  5. Click Retrieve Settings.
  6. If you receive any errors, contact Eyefinity Customer Support.
  7. Click Save.
VSP records indicate that this provider is not associated with your office or has not registered NPI with VSP. Contact VSP Customer Service for assistance. The VSP Provider NPI, credentials, or both are not set up properly or do not match those in eyefinity.com. Do the following:
  1. Verify that the doctor is listed in the office's eyefinity.com account.
  2. If the doctor is not listed, contact Eyefinity Customer Support, or select a different doctor.
  3. If the doctor is listed, open the claim in the Edit Claim window in AcuityLogic Billing, and verify that the claim has the correct provider NPI, provider number, and tax ID.
  4. If any of the information is missing or incorrect, update the information in the claim, and set the claim to Ready to Bill.
  5. To permanently fix the information, open AcuityLogic Admin, click Company, and select Company Setup.
  6.  In the Company Information window, do the following:

    To fix the provider NPI:

    1. Click your company's Employees link.
    2. Find the doctor.
    3. Click the doctor's last name link.
    4. In the Employee window, update the value in the National Provider Id field.

    To fix the provider number:

    1. Click your company's Add. Carrier Att. link.
    2. In the Company Carrier window, find VSP.
    3. In the VSP row, click Provider Mgmt.
    4. In the Provider Number Management window, add or update the doctor's Provider Number for the appropriate location.

    To fix the tax ID:

    1. Click your company's Offices link.
    2. In the Company Offices window, click your office's Office # link.
    3. In the Office Information window, click the Billing Information button.
    4. In the Billing Information window, update the Billing EIN (Employer Identification Number) value.
Invalid User Id and/or Password. Your eyefinity.com credentials may have been changed in error. Do the following:
  1. In AcuityLogic Admin, click Insurance, and select Screen Scraping Management.

    The Screen Scraping Management window opens.

  2. From the Location Name drop-down list, select your office.
  3. From the Carrier Name drop-down list, select VSP.
  4. In the VSP section, update your office's eyefinity.com login name and password.
  5. Click Retrieve Settings.
  6. If you receive any errors, contact Eyefinity Customer Support.
  7. Click Save.
Incorrect Store Login information. Unable to process claim. The VSP integration is not set up properly, or your office has changed your eyefinity.com credentials. Do the following:
  1. In AcuityLogic Admin, click Insurance, and select Screen Scraping Management.

    The Screen Scraping Management window opens.

  2. From the Location Name drop-down list, select your office.
  3. From the Carrier Name drop-down list, select VSP.
  4. In the VSP section, update your office's eyefinity.com login name and password.
  5. Click Retrieve Settings.
  6. If you receive any errors, contact Eyefinity Customer Support.
  7. Click Save.
Invalid Authorization number. The authorization number used on the order no longer exists. You may have deleted the authorization number on eyefinity.com or in your previous OfficeMate system. Or the claim may already have been submitted on eyefinity.com. Log into eyefinity.com and verify that the claim was billed. If it was billed, change the claim status to Billed in AcuityLogic. If it was not billed, get a new authorization number from VSP, and remake the order with the new authorization.
COB --> The plan benefit review is required for secondary claims. AcuityLogic automatically places all secondary coordination of benefit claims on hold. Process the claim.
The retinal screening code requires a modifier 52. Please correct and resubmit. The modifier 52 was not added before the claim was submitted to VSP. Log into eyefinity.com, add the modifier to the claim, and submit. Then, in AcuityLogic, change the claim status to Billed. For future retinal screening exams, add modifier 52 before invoicing.
Failed to submit order due to error(s)1 : VSP has detected that the following CPT/HCPCS codes should also be submitted with your request. V2799 V2799 is a code for Technical Add On. VSP expects the claim to have a charge for this item, but it was not included on the eyeglass order. Log into eyefinity.com, add pricing for the V2799 line item on the claim, and submit. Then, in AcuityLogic, change the claim status to Billed. Verify that the "V2799 Technical AddOn A" item has been priced and activated in AcuityLogic Admin. On future orders, add the item.
Billed amounts must be greater than $0 to $999.99. Please indicate your U&C charge or delete the line for procedure code V2702. V2702 is a code for Custom Measurements. VSP expects the claim to have a charge for this item, but it was not included as a misc. item on the eyeglass order. Log into eyefinity.com, add pricing for the V2702 line item on the claim, and submit. Then, in AcuityLogic, change the claim status to Billed. Verify that the "V2702 Custom Measurements" miscellaneous extra has been priced and activated in AcuityLogic Admin. On future orders, add the item as a miscellaneous extra.
Billed amounts must be greater than $0 to $999.99. Please indicate your U&C charge or delete the line for procedure code V2750. Procedure code V2750 AR Coating is not priced in AcuityLogic Admin. Log into eyefinity.com and add pricing for the V2750 line item on the claim and submit. Then, in AcuityLogic, change the claim status to Billed. Verify that the V2750 AR Coating has been priced and activated in AcuityLogic Admin.
Billed amounts must be greater than $0 to $999.99. Please indicate your U&C charge or delete the line for procedure code V2762. Procedure code V2762 Polarized Lens is not priced in AcuityLogic Admin. Log into eyefinity.com, add pricing for the V2762 line item on the claim, and submit. Then, in AcuityLogic, change the claim status to Billed. Verify that the V2762 Polarized Lens color is priced and activated in AcuityLogic Admin.
Billed amounts must be greater than $0 to $999.99. Please indicate your U&C charge or delete the line for procedure code V2780. V2780 is a code for the Oversized Eyeglass Lens Extra attribute. VSP expects all claims to have a charge for this item for frames over 61 mm eye size, but it is not priced in AcuityLogic Admin. There is also an out-of-pocket patient expense for most plans. Log into eyefinity.com, add pricing for the V2780 line item on the claim, and submit. Then, in AcuityLogic, change the claim status to Billed. Verify that the V2780 Oversized Eyeglass Lens Extra is priced and activated in AcuityLogic Admin.
Billed amounts must be greater than $0 to $999.99. Please indicate your U&C charge or delete the line for procedure code V2781. Either procedure code V2781 Progressive Lens Style is not priced in AcuityLogic Admin, or the lens selected on the order is set up incorrectly in the database. Log into eyefinity.com, add pricing for the V2781 line item on the claim, and submit. Then, in AcuityLogic, change the claim status to Billed. Verify that the V2781 Progressive Lens Base and Style are priced and activated in AcuityLogic Admin.
Invalid services selected. You may not select Elective Contacts or Covered Contacts with Lenses. Order includes an exam, eyeglass frame, lens, and contact lens fitting fee. VSP claims can contain either eyewear or contact lenses, not both. Delete the 92310 line from the claim, and change the claim status to Ready to Bill so it can be processed. When creating future orders, deselect the check box for the contact lens fitting fee on the Pricing screen to exclude it from the claim.
Diagnosis Code has the following error(s). \r\nH52.13 - is not valid diagnosis code for the benefit type. \r\n\r\nCorrect invalid codes and resubmit. ICD10 code H52.13 is Myopia Bilateral. CVC plans do not cover this diagnosis code for claims processing. Check the CVC guidelines on VSP Online to verify the correct diagnosis codes to use. Go to eyefinity.com, change the diagnosis code, and submit. Change the claim status to Billed in AcuityLogic.
Unable to Calculate - Elective contact lens service in not available. The eyeglass or exam order includes a contact lens fitting fee. VSP claims can contain either eyewear or contact lenses, not both. Delete the contact lens fitting fee from the claim, and change the claim status to Ready to Bill so it can be processed. When creating future orders, deselect the check box for the contact lens fitting fee on the Pricing screen to exclude it from the claim.
Unable to Calculate - Elective contact lens service in not available. The order includes an exam not covered by the VSP authorization. Delete the exam from the claim and change the claim status to Ready to Bill so it can be processed. When creating future orders, deselect the check box for the exam on the Pricing screen to exclude it from the claim.
Unable to Calculate - Spectacle lens service is not available. The order includes an eyeglass lens not covered by the VSP authorization. Delete the lens from the claim and change the claim status to Ready to Bill so it can be processed. Create a separate order for the non-covered lens.
Please specify contact lens brand. Contact lens database is not set up properly. Do the following:
  1. Verify that the order refers to a valid contact lens.
  2. If it is valid, open AcuityLogic Admin, click Product, select Contact Lens, and select Contact Lens.
  3. In the Contact Lens window, find the contact lens, and click its Map Partners link.

    The Partner Mapping window opens.

  4. In the Eyefinity (E-Claim) row, enter the lens style name or the word Other.