Applying VSP Insurance as Secondary Insurance on Exam Orders

When you create exam orders, you can apply VSP as the secondary insurance when the primary insurance is a medical insurance plan.

Claims for medical/VSP coordination of benefits must include both a primary medical diagnosis code and a routine vision diagnosis code, and all line items on the order must be exam-only.
  1. Create the exam order and click Save.
  2. In the Pricing screen, click the Add link to add a medical insurance plan as the Primary Insurance.

    The Select Insurance window opens.

  3. Select Exam/Contact Lens Exam and click Calculate Benefits next to the medical insurance plan.
  4. Enter the Insurance Reimbursement amounts that the medical insurance will cover in the Manual Calculation window and click Save.
  5. If the patient has VSP insurance in the system, a message appears, stating that the patient might be eligible to coordinate benefits. Click Check VSP Eligibility/Authorization to open the Eligibility/Insurance screen in another tab.
    6. Click theRefer to Provider Reference Manual link to open the VSP Coordination of Benefits Quick Reference Guide. This guide contains information about determining and applying benefits, and how to submit coordination of benefits claims.

  6. If the patient has an active VSP authorization for exams, return to the Pricing screen and click theAddlink to add it as the Secondary Insurance.

    The Select Insurance window opens.

  7. Select Exam/Contact Lens Exam and click Calculate Benefits next to the VSP plan.
  8. In the VSP Calculation window, click Override and enter the amounts that VSP will cover (for example, the refraction fee).
    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
  9. Click Save.
  10. Click Save & Invoice.

    After you generate the invoice:

    • The primary medical claim is created, and automatically includes the secondary VSP insurance information. The claim is set to Ready to Bill status. Process it as you normally would.
    • The secondary VSP claim is set to On Hold status. For instructions on processing the claim, see Processing Claims for VSP Secondary Coordination of Benefits.