Pricing and Adding Insurance to Orders

Open the Order Review screen in one of the following ways:

• To price a new order as you are creating it, click Continue to Pricing on the Order Summary screen.
• To price an existing order that has not been invoiced:
  1. Click Material Orders in the left-side navigation menu.
  2. On the Non-Invoiced tab, locate the order you want to price.
  3. Select Price from the Actions drop-down list next to the order.

Use this procedure to edit items other than accessories. Discounts and insurance are removed from the order when you edit an item.

1. In the Order Review screen, locate the item you want to edit and click the pencil icon.

   The Order Summary screen (for eyeglass and contact lens orders) or Edit Exam screen (for exam orders) opens.

2. Make changes to the item or exam, as necessary.

3. Click Continue to Pricing (for eyeglass and contact lens orders) or Save and Price Exam (for exam orders) to return to the Order Review screen.

You can't edit accessories, but you can change the quantity you're ordering by clicking the number in the Qty column.

1. Check the Provider drop-down list to make sure the correct provider is selected. 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.
   • Exam-only orders default to the provider on the exam.

2. In the item list, select the check boxes next to the items you want to apply insurance to. Claims will list only the items you select.

3. Select the insurance plan from the Insurance drop-down list. The list displays only those plans with active authorizations and shows which eligibilities are available.

   The Insurance Calculation window opens.

4. Click Calculate Benefits.

   The Insurance Calculation window updates to display the calculation fields.

5. Enter the Patient Responsibility, Patient Copay, and/or Insurance Reimbursement amounts, as necessary, to make automatic calculations. For non-VSP manual calculation plans, amounts are initially allocated by default to the Patient Responsibility column. Make edits to allocate amounts to the other columns, as necessary.
6. Click Save.

The insurance is applied to the selected items. The item list is updated with an Insurance: label that includes the name of the insurance and whether the plan is Vision, Medical, or Vision and Medical. If an item has more than one insurance applied, a separate label for each insurance is displayed.

• If the insurance has an available Patient Record Report, the label is shown as a link. Click the link to see the report.

• To remove the insurance, click the X in the label.

1. Check the Provider drop-down list to make sure the correct provider is selected. 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.
   • Exam-only orders default to the provider on the exam.
   • For VSP orders, only VSP providers appear in the Provider drop-down list.

2. In the item list, select the check boxes next to the items you want to apply insurance to.

   • 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.
   • 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.

3. Select a VSP insurance plan from the Insurance drop-down list. The list displays only those plans with active authorizations and shows which eligibilities are available.

   The VSP Insurance Calculation window opens.

4. Click Calculate Benefits.

   The VSP Insurance Calculation window updates to display the calculation information automatically pulled from VSP.

   If you need to change the amounts, click More Actions and then select Calculate Manually. You can also use Calculate Manually if the automatic calculation fails. For VSP plans that do not have automatic benefit calculation, such as VSP Medicaid, you will be prompted to enter the amounts manually. For a list of plans that have automatic calculation, see VSP Plans Available for Automatic Benefits Calculation.

   If you use Calculate Manually and leave the Insurance Reimbursement amount at $0.00, the claim will be marked Non-Receivable.

5. Check for any warning or error messages. Warning and/or error messages display in the VSP Insurance Calculation window if the patient's benefits cannot be calculated due to problems with the order. You cannot proceed with the order until the warnings and/or errors are corrected or acknowledged. For a list of all the possible error and warning messages, along with explanations and examples, see Warnings and Errors in the VSP Interface.

   • Error messages display in red and reflect conditions that must be corrected before the order and claim can be submitted. Perform one of the following:

     • To open the order summary and correct the issue described in the error message, click Edit Order.
     • To remove the VSP insurance and proceed with the order without insurance, click More Actions and select Continue Without Insurance.
   • Warning messages display in yellow and reflect conditions that may cause your claim to go on hold, but which will not prevent the order and claim from being submitted. Perform one of the following:
     • To correct the issue, click Edit Order to open the order summary.
     • To perform the calculation and proceed with the order without correcting, click Acknowledge & Re-Calculate.
     • To remove the VSP insurance and proceed with the order without insurance, click More Actions and select Continue Without Insurance.
6. Click Save.

The insurance is applied to the selected items. The item list is updated with an Insurance: label that includes the name of the insurance and whether the plan is Vision, Medical, or Vision and Medical. If an item has more than one insurance applied, a separate label for each insurance is displayed.

• If the insurance has an available Patient Record Report, the label is shown as a link. Click the link to see the report.

• To remove the insurance, click the X in the label.

Once you have applied insurance to items, you can select to apply another insurance plan for coordination of benefits.

1. Select the insurance you want to apply from the Coordination of Benefits drop-down list.

   The Insurance Calculation window opens.

2. Click Calculate Benefits.

   The Insurance Calculation window updates to display the calculation fields. The amounts shown reflect what is left after the primary insurance is applied.

3. Complete the calculation as described in Add non-VSP insurance to an order or Add VSP insurance to an order

1. Click the Line Discount or Global Discount link at the top of the item list.

   The Line Discount or Global Discount window opens. The Line Discount window lists all items on the order that are eligible for discounts.

2. Select the Discount Type. You can apply the discount as either a percentage off or a fixed dollar amount off.
3. Enter the Discount Value.
4. Select the Discount Reason.
5. For line discounts, repeat steps 2-4 for each item you want to discount.
6. Click Apply Discount.

To remove a discount, hover over it and click the X.

1. In the Order Summary panel, click the Tax link.

   The Tax Rate Breakdown window opens.

2. Click the down arrow next to an item.

3. Edit the Tax Rate for each tax authority shown, as necessary. The Tax Rates default to those set up for your office in Administration.
4. Select one of the following options in the Tax Calculation drop-down menu, if needed:
   • Select Apply Tax To Net Price to calculate tax for the item based on the net price after discounts. This is the default option selected.
   • Select Apply Tax To Retail Price to calculate tax for the item based on the retail price.
   • Select Apply No Tax to not charge tax for the item.
5. Repeat steps 2-4 for each item, as necessary.
6. Click Continue to close the window and return to the Order Review screen.

If enabled in Administration, you can enter a promise date and/or invoice comment to include on the order and print on the patient's receipt.

To add a promise date—Click the Promise Date drop-down field and enter a date or select a date from the calendar.

To add an invoice comment—Click the Invoice Comments drop-down field and enter a comment up to 200 characters long.

1. Click Diagnosis Codes.

   The View/Edit Diagnosis Codes window opens and displays any codes the system has automatically added to the order.

2. Edit the codes and/or add new ones, as necessary. Additional fields will become available as you add codes, up to a total of 12.

3. Click Save.

To help prevent claims from going on hold due to missing modifiers and dispensing fees, a message displays at the top of the Order Review screen to prompt you to enter this information, if required by theselected insurance plan. For VSP Medicaid orders, the Save buttons at the bottom of the Order Review screen are unavailable and you will not be able to complete pricing until you have selected the modifiers and/or fees.

For information on setting up dispensing fees in Administration, see Setting Up Miscellaneous Fees.

1. In the Order Review screen, locate the "You may need to add modifiers..." message above the line item list.
2. Click the Add/Review link in the message.

The Add Modifiers and Dispensing Fee window opens.

3. Select up to four Modifier Codes for each item.
4. Select the Dispensing Fee.
5. Enter an amount for the dispensing fee, if necessary.
6. Select up to four Modifier Codes for the dispensing fee.
7. Click Save.

When you're done pricing the order, 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
  If this option is unavailable, go to Administration and check the status of your Frames Data subscription integration.
• Save & Invoice—Generates the invoice immediately