Adding VSP Insurance and Authorizations Using E-Eligibility

This section explains how to add a patient's VSP insurance plan information and get authorizations using the e-Eligibility feature.

Topics include:

• Adding E-Eligibility Insurance Information for VSP Plans
• Adding Authorizations for VSP
• Adding Manual Authorizations for VSP
• Related Topics

Adding E-Eligibility Insurance Information for VSP Plans

Use this procedure to search for VSP members and their dependents, and either update or add new information to your system.

1. Perform one of the following to access the e-Eligibility - Member Search screen:
   • In the top menu bar, click Patients and select Search/Add Patient. Enter the patient search information, then click + E-Eligibility Insurance.
   • With an existing patient's Demographics screen open, click Insurance on the left-side menu, then click + E-Eligibility Insurance.
2. Select VSP.

   The VSP e-Eligibility - Member Search screen opens. If the patient already has VSP insurance recorded in their profile, the subscriber information recorded for the plan displays in the search fields. Otherwise, the patient's information displays.

3. If necessary, search for the VSP member by performing one of the following:
   • Type or edit the member's Last Name, First Name, Date of Birth, and Last 4 SSN, and click Search Carrier, or
   • Enter the VSP Member ID and click Search Carrier.

   Otherwise, wait for the e-Eligibility system to locate the member.

The member's personal and insurance information display, along with the member's current eligibilities and authorizations for each plan in which they are enrolled. If the member has dependents covered by the plan(s), their eligibilities are also shown.

If no results are found, a message displays, indicating the reason. You may be asked to enter the patient's Zip Code to help refine the search.

You can add the authorization manually, if necessary. See Adding Authorizations for VSP for instructions.

4. Select the check box(es) next to the name(s) of the patient(s) you want to record insurance information for. You can select multiple patients. The member you searched for is automatically selected, but you can deselect them.

   To exit e-Eligibility:

   • Click the Back to Patient Search link, if no results were found or the patient is not an existing patient.
   • Click the Back to Patient Insurance link if the patient is an existing patient. The patient's Insurance screen opens.
5. If required, enter the DOB for the selected patient(s).
6. Click Add or Update Patient. If any information is missing for the subscriber, the Subscriber Information window opens. Enter the required information and click Continue.

   The Insurance information retrieved from the e-Eligibility system is added to the patient's existing record (existing patients) or a new patient record (new patients).

   • For existing patient(s), the Insurance: Eligibility/Authorization screen opens and displays the insurance you added. The patient's Demographics record is updated with the personal information retrieved from VSP, if necessary. If the patient is a dependent, the member is shown as the patient's Responsible Party.
     If the date of birth retrieved from VSP is different from the one already in the patient's Demographics record, the Date of Birth Does Not Match window opens. You can select to update Demographics with the retrieved birth date or keep the record as-is.
   • If the patient is a new patient, the Demographics screen opens and displays the patient's personal information retrieved from the e-Eligiblity system. If the patient is a dependent, the member is shown as the patient's Responsible Party. Enter any additional required Demographics information to finish creating the patient record and click Save. For more information, see Adding a New Patient.

     The patient's insurance plan(s) and authorization(s) are automatically added to the new patient record. You can see the authorization(s) by going to the patient's Eligibility/Authorization screen. For more information, see Viewing Patient Insurance Information.

   • If you are adding multiple new patients, the member patient's Insurance: Relationships screen opens. Separate records are created for each patient using the personal information retrieved from VSP. Go to the patients' Demographics screens and enter any additional required Demographics information to finish creating the patient records and click Save. For more information, see Adding a New Patient.
   New patient records created using this process have a "Customer Created from e-Eligibility" Profile note added. The note displays in the Correspondence: Notes screen for the patient. For more information about notes, see Viewing and Recording Other Notes

Adding Authorizations for VSP

Before adding VSP eligibilities and authorizations, you need to create a separate VSP carrier and plan for each benefit type. You can authorize insurance benefits only for the benefit type that corresponds to the VSP plan you have selected. For more information on creating carriers and plans, go to Adding VSP Insurance and Authorizations Using E-Eligibility.

Follow this procedure to add a VSP authorization for an individual existing patient.

1. On the left side of the Demographics screen, under Insurance, click Eligibility/Authorization.
2. Locate the VSP plan that corresponds to the benefit type for which you want to add eligibilities and click Eligibility and Authorization.
   • If the plan was added to the patient using the e-Eligibliity feature, Encompass obtains the patient’s member details and eligibilities from VSP and displays them in the Eligibility/Authorization window.
   • If the plan was added to the patient manually (without using e-Eligibility), or if no eligibilities were found, click Manual Authorization to enter the eligibilities manually. VSP patient out-of-pocket calculations are not performed for authorizations you enter manually. For information on entering eligibility information, go to Adding Eligibilities for Vision Plans Other Than VSP.
     You can also use Manual Authorization If Encompass cannot connect to the VSP system and a Connection Failed message displays.
3. An authorization number link for the eligibility appears in the Number column, under Authorization. Click the link to add notes for the eligibility, if necessary.
4. To view and print the Patient Eligibility Report, click the icon in the Benefits column, under Authorization.

   The report is not available for authorizations entered manually.

Adding Manual Authorizations for VSP

VSP patient out-of-pocket calculations are not performed for authorizations you enter manually.

1. On the left side of the Demographics screen, under Insurance, click Eligibility/Authorization.
2. Locate the VSP plan that corresponds to the benefit type for which you want to add eligibilities and click Eligibility and Authorization.

   The Eligibility And Authorization window opens.

3. Click Manual Authorization.

   The Eligibilities window opens.

4. Enter the authorization information. See Adding Eligibilities for Vision Plans Other Than VSP for more information.

Related Topics

• Adding Non-VSP Insurance and Authorizations
• Viewing Patient Insurance Information