Pricing and Adding Insurance to Orders

Pricing an order allows you to apply discounts, tax, and the patient’s primary and secondary insurance plans to the order. All orders must be priced after they are created so that they can later be invoiced. For more information, go to Invoicing Orders.

  1. Access the Current Pricing screen using one of the following methods:
    • Select Price from the Actions drop-down list in the Pending Orders list in Material Orders.
    • Click Continue to Pricing in the Order Summary screen when creating or editing an order.

      If you have Eyefinity EHR integrated with Eyefinity Practice Management and your practice has Exam Auto-Posting enabled in Administration, note the following:

      If the patient has one or more pending Eyefinity EHR exams, the most recent EHR exam is automatically added to the order when you click Continue to Pricing, if the order does not currently include an exam. A message displays at the top of the Current Pricing screen, notifying you that the exam has been added. If the order cannot be added due to issues with the exam, such as missing information, a message displays with a link to open the exam for editing. You can delete individual Eyefinity EHR exam services from an order when they have been added automatically if you have the Delete Exam from Order security permission. The services remain in the system (listed under Pending Exams in the Exams screen) and are available to use on a different order. They also continue to be listed on the Patient Open Exams Report.

  2. If the Add Shipping Fee window opens, select a Shipping Method for the order. For information on how the shipping methods listed correspond to ABB Concise's shipping methods. see Shipping Methods for ABB Ordering.
  3. Click the links under Optional: Select additional items to add to the order to add additional items to the order.

    For more information, go to Creating Exam or Other Orders.

  4. If any item does not have a price:
    1. Click the $0.00 link in the Price column.
    2. Record the Retail Price.
    3. Click Update Price.
    • VSP orders require that all lens, frame, and extra items have prices greater than $0.00, and the system will prompt you to enter any missing prices and prevent you from proceeding with the order until you do so.
    • For Non-VSP orders, items with the Zero Price? check box selected in the Products/Services setup screen in Administration can have a $0.00 price. All other items must have a price greater than $0.00 before you can save the order.
    • If the item is a frame, the retail price is saved and used for future orders.
    • For more information on setting prices for items in Administration, go to Setting Up Products/Services.
  5. Deselect the check box next to each item you do not want to bill to insurance (patient out-of-pocket items). All items are selected for insurance billing by default.

    • For VSP eyeglass orders that also include a contact lens fitting fee, be sure to deselect the check box for the fitting fee. VSP claims can contain either eyewear or contact lenses, but not both. Billing both together with cause your claim to go on hold.
    • Non-VSP claims will list only the items you select. VSP claims may list some items not selected because VSP requires that all items sent to the lab are listed on the claim, even if they are not covered. All items on the order will appear on the invoice.
  6. Select the Provider for the order.

    This provider information is included on the claim and sent with your electronic claim submissions.

    • Eyeglass and contact lens orders default to the provider who wrote the prescription, unless he or she is an outside provider. Orders with outside provider prescriptions default to the provider listed in the patient demographic record.
    • For VSP orders, only VSP providers appear in the Provider drop-down list.
  7. If the patient has insurance:
    1. Click the Add link next to Primary Insurance.
    2. Select the check boxes for the item types to which the insurance applies.
    3. Click Calculate Benefits.
    4. For non-VSP insurances, the Manual Calculation window opens. Change the Patient Responsibility, Patient Copay, and/or Insurance Reimbursement amounts to make calculations.

      Only providers and staff members with the Manual Calculation security permission selected in Administration can access the Manual Calculation window. If you do not have this security permission, an Access Denied - Temporary Override window displays, allowing another user with permission to enter their username and password and give you temporary access. For information on setting security permissions, see Setting Up Provider Security Settings and Setting Up Staff Security Settings

    5. When pricing orders using a VSP Signature or VSP Choice plan as the primary insurance, Eyefinity Practice Management obtains this information automatically from VSP. Click Override to change the amounts, if necessary. Other VSP plans that do not have automatic benefit calculation, such as VSP Medicaid, may require you to use Override to enter the amounts manually.

      • If you use Override and leave the Insurance Reimbursement amount at $0.00, the claim will be marked Non-Receivable
      • Only providers and staff members with the Override VSP Calculation security permission selected in Administration can use the Override feature. If you do not have this security permission, an Access Denied - Temporary Override window displays, allowing another user with permission to enter their username and password and give you temporary access. For information on setting security permissions, see Setting Up Provider Security Settings and Setting Up Staff Security Settings

      You can click the Patient Record Report icon to view the VSP Patient Record Report or the Medical Plan Summary Report.

    6. Click Save.
    7. To apply a secondary insurance, click the Add link next to Secondary Insurance and repeat steps a through e.
  8. To add modifiers and/or a dispensing fee, click the Add/Review link.

    For more information, go to Adding Modifier Codes and Dispensing Fees to Orders.

  9. To apply a line discount to an item:
    1. Click the link in the Line Discount column.
    2. Record the discount information in the Discount window.
    3. Click Apply Discount.
  10. To apply a global discount:
    1. Click one of the links in the Global Discount column.
    2. Record the discount information in the Discount window.
    3. Click Apply Discount.
  11. To enter or edit the tax rate for an item, click the Tax link. For more information on calculating tax for orders, go to Calculating Sales Tax .
    Only providers and staff members with the Edit Sales Tax security permission selected in Administration can edit the tax rate. If you do not have this security permission, an Access Denied - Temporary Override window displays, allowing another user with permission to enter their username and password and give you temporary access. For information on setting security permissions, see Setting Up Provider Security Settings and Setting Up Staff Security Settings
  12. Enter or select a promise date in the Promised Date text box, or select a date from the calendar.
  13. Enter an Invoice Comment, if needed. This text will appear on the patient's receipt.
  14. Click one of the following:
    • Save—saves the order for invoicing later
    • Save & Add Another—saves the order for invoicing later and starts a new contact lens or eyeglass order
    • Save & Invoice—generates the invoice immediately

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