Adding Non-VSP Insurance and Authorizations

This section describes how to record a patient’s insurance plan and insurance relationship information for carriers other than VSP. Topics include:

Adding Non-VSP Insurance Information

  1. On the left side of the Demographics screen, click Insurance.
  2. Click + Other Insurance.
  3. Under Carrier Information, select the Carrier Name and Plan Name.

    If the carrier you need is not listed in the Carrier Name drop-down list, select Unknown Carrier and Unknown Plan and enter the rest of the insurance information manually. The claim for the order will need to be corrected before submitting. For more information, see Generating the Not listed Insurance Plans Report.

  4. Select whether this is the patient’s Primary Insurance.
  5. Under Subscriber Information, record the Insured ID number, or select Use Patient SSN to use the social security number in the patient profile.
    • If you enter the Insured ID, the system checks to make sure the number entered matches the format required for the carrier and plan.
    • The insured ID number or social security number appears in box 1a on the CMS 1500 form.
  6. Select the patient’s Relationship to Subscriber.
  7. Record the Subscriber Name, Address, and Phone Number.

    The address appears in box 7 on the CMS 1500 form.

  8. Record the subscriber’s Birth Sex and Date of Birth.

    The subscriber’s sex and date of birth appear in box 11a on the CMS 1500 form.

  9. Record the subscriber’s Employer.

    The subscriber’s employer appears in box 11b on the CMS 1500 form.

  10. Record the Group Number and Group Name for the insurance, if necessary.

    The group name appears in box 11c on the CMS 1500 form.

  11. Click Save.

    If you have Eyefinity EHR integrated with Eyefinity Practice Management, the patient’s insurance information is automatically sent to Eyefinity EHR.

Adding Eligibilities for Vision Plans Other Than VSP

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

    If the plan is not listed, check the patient's Insurance screen to see if there are any error notifications and correct the plan information before proceeding. If you need to add the plan, see Adding Non-VSP Insurance Information.

  3. Select at least one Eligibility/Authorization Type.
  4. Record the Authorization Number.
  5. Record the Authorization Date, or click the calendar icon and select a date.
  6. Record the Expiration Date, or click the calendar icon and select a date.
  7. Record any Notes you want to include with the eligibility.
  8. Select or enter any additional required information.
  9. Click Save.

    The eligibilities appear in the Eligibility/Authorization window. To edit them, click the Auth # link .

    For an explanation of the eligibility status icons, go to Viewing Patient Insurance Information.

Adding Eligibilities for Medical Plans

When you add a medical plan eligibility, you can enter all the plan information required to quickly check out patients, including copays, deductible amounts, coinsurance, out-of-pocket maximums, provider information, and more. To edit the eligibility later, click the icon in the Eligibility column in the Eligibility/Authorization screen.

If your practice has TriZetto integrated with Eyefinity Practice Management, you can import eligibility information automatically from TriZetto. For more information, see Adding Eligibilities Using the TriZetto Integration.

Entering Medical Eligibility Coverage Details

  1. On the left side of the Demographics screen, under Insurance, click Eligibility/Authorization.
  2. Locate the medical plan to which you want to add eligibilities and click Eligibility. If the plan is not listed, see Adding Non-VSP Insurance Information.

    The Eligibilities window opens.

  3. Enter the Authorization Number.
  4. Enter the Authorization Date, and Expiration Date.
  5. The Medical Exam check box is selected by default. If you deselect this check box, you must select at least one eligibility under Vision Coverage (see step 15).
  6. On the Coverage tab, under Individual, enter the Deductible Amount.
  7. Select whether the deductible has been met. If No, enter the Remaining Deductible Amount.
  8. Type the Deductible Renewal Date, or click the calendar icon and select a date.
  9. Enter the Out of Pocket Maximum and Remaining Out of Pocket Maximum.
  10. Select whether Durable Medical Equipment is covered.
  11. Enter the Office Copay and Specialist Copay amounts.
  12. Enter the Co-insurance percentage.
  13. Enter the Group Policy Number and Plan Number.
  14. Select whether the plan is a Coordination of Benefits plan.
  15. Under Family, enter the deductible information for any dependents.
  16. Select whether the plan includes Vision Coverage. If Yes, select the vision coverage eligibility/authorization types and enter the copay and allowance amounts.
  17. Enter the Primary Care Physician details.
  18. Click Claim Details and go to Entering Medical Eligibility Claim Details

Entering Medical Eligibility Claim Details

  1. Select whether an Intraocular Lens (IOL) Surgery was performed.
  2. Enter the Referring Provider Name and NPI Number. This information appears in boxes 17 and 17b on the CMS 1500 form.
  3. Select whether the patient has a Post Cataract Benefit.
  4. Enter the Surgery Date, Surgery Eye, and Relinquished Care Date, if applicable. This information appears in box 19 on the CMS 1500 form.
  5. Select whether the condition is related to an auto accident. If Yes, enter the Auto Accident State and Accident Date. This information appears in box 15 on the CMS 1500 form.
  6. Select whether the condition is related to the patient's employment.
  7. Check that the information under Vision and Primary Care Physician is correct and edit if necessary.
  8. Click Save.
  9. The eligibility is added to the Eligibility/Authorization screen.

Editing Medical Eligibilities

  1. In the Eligibility/Authorization screen, locate the medical plan eligibility you want to edit.
  2. Click the icon in the Eligibility column.
  3. The Eligibilities window opens.

  4. Edit the Coverage information and Claim Details, as necessary.
  5. Click Save.

Viewing the Medical Plan Summary

  1. In the Eligibility/Authorization screen, locate the medical plan eligibility.
  2. Click the icon in the Report column.
  3. The report opens in another window. Click the Print icon to print the report, if desired.