Pricing and Adding Insurance to Orders

Use the Current Pricing screen 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. Open the Current Pricing 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.
      If you have Eyefinity EHR integrated with Eyefinity Practice Management, and 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.
    • 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.
  2. 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-Only Orders and Adding Exams to Orders or Ordering Miscellaneous Items

  3. For Eyeglass Lens item types, click the link in the Item Type/Code column to view detailed pricing information for the lens attributes, including discounts and insurance allowances and copays.
    Hover your mouse over any of the entries in the Item Type/Code column to see the name of the item.
  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.
    • 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.
    • Exam-only orders default to the provider on the exam.
    • 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.

      The Select Insurance window opens and lists the patient's available authorizations.

    2. Select the check boxes for the item types to which the insurance will apply.
    3. Locate the authorization you want to apply to the order.
      • If the authorization has a red exclamation mark icon, it has missing information that you need to enter before you can use it on the order. Click the Need Info link below the icon to go to the Eligibilities window and add the missing information.
    4. Click Calculate Benefits.

      • A message displays if you have selected a full service authorization and the order only requires partial benefits. If desired, click the Delete this auth and request a partial benefit auth to delete the authorization and go to the Insurance: Eligibility/Authorization screen to obtain a new split authorization to use on this order. Otherwise, click Calculate Benefits again.

      • If the order does not match the order type requirements for the plan (for example, the order is a frame only order and the plan only allows complete eyeglass orders), a message displays. Edit the order or select a different insurance to continue.

    5. If the Additional Information window opens, enter or select the requested information and click Continue.
      If the insurance plan is set up for variable allowances and copays, the Additional Information window prompts you to select the amounts for each. The available amounts are set by your Administrator.
    6. In the Calculation window, enter the Patient Responsibility, Patient Copay, and/or Insurance Reimbursement amounts, as necessary, to make automatic calculations.

      7. 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 Calculate Manually 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 this feature to enter the amounts manually. You can also use Calculate Manually if the automatic calculation fails.

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

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

      These reports are not available for VSP authorizations that were entered manually.
    7. Click Save or Continue.

      The Current Pricing screen updates to show the calculated amounts in the Primary Ins. and Second Ins. columns, as appropriate.

    8. 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 During Pricing.

  9. To apply a Pricing Option, select one from the drop-down list and click Reprice.
  10. 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.
  11. 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.
  12. To enter or edit the tax rate for an item, click the Tax link. .
  13. Enter or select a promise date in the Promised Date text box, or select a date from the calendar.
  14. Enter an Invoice Comment, if needed. This text will appear on the patient's receipt.
  15. 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

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