Warnings and Errors in the VSP Interface
This section lists all the warnings and errors that you might encounter in the VSP interface:
- VSP Warnings — To continue processing a VSP order or claim after receiving a warning, you can either fix the error specified in the warning or acknowledge the error without fixing it.
- VSP Errors — You must fix all VSP errors before you can submit a VSP order or claim.
For more information, see Using the New VSP Interface.
VSP Warnings
The following table provides information about all the warnings you might see in the VSP interface:
VSP Errors
The following table provides information about all the errors you might see in the
| Error ID | Error Text | Generic Processor Message |
Explanation | Examples |
|---|---|---|---|---|
|
ADJCOB0001 |
Coordination of Benefits is not allowed |
— |
For COB between two or more VSP plans: When all products are under the same client and COB rule 1 applies to all products, COB is not allowed. |
COB claim for John Doe: He works at the same client as his spouse, and rule 1 applies to both benefits. - VSP primary product = Signature and relationship on benefit is Member. - Secondary product = Signature and relationship on benefit is Spouse. |
|
ADJCOB0002 |
Coordination of Benefits is not allowed between two benefits on the same members plan |
— |
For COB between two or more VSP plans: When the members' products are under the same client using the same member ID and COB rule 11 does not apply, COB is not allowed. This is typical for members who have first- and second-pair benefits. |
COB claim: Member ID is the same on both products, and client IDs are the same. - VSP primary product = Signature. - Secondary product = Signature second pair. |
|
ADJCOB0003 |
Medicaid is always the payer of last resort. Benefits cannot be coordinated with Medicaid as Primary plan |
— |
For COB between two or more VSP plans: Medicaid should be reserved as the secondary product to any active plan. An exception is made when all products are Medicaid. |
COB claim: - VSP primary product = Medicaid. - Secondary product = Signature. |
|
ADJCOB0004 |
COB is not allowed for secondary Product Package |
— |
For COB between two or more VSP plans: There are restrictions on which products can be coordinated with others. In these cases, the secondary plan cannot be coordinated with the primary (or possibly at all). There are many instances of this. |
COB claim: - VSP primary product = VSP Elements. - Secondary product = PEC. |
|
ADJCOB0005 |
Primary claim must be under the Member Relationship. Coverage as Dependent is always secondary |
— |
For COB between two or more VSP plans: When the primary product is for a dependent relation and the secondary product is for a member relation, COB is not allowed. A member relation must be primary over a dependent. An exception is made for Medicaid products (where Medicaid must be secondary regardless of the relationship order). |
COB claim for John Doe: - VSP primary product = Signature and relationship on benefit is Spouse. - Secondary product = Signature and relationship on benefit is Member. |
|
ADJCOB0006 |
COB is not allowed for primary Product Package |
— |
For COB between multiple VSP plans: There are restrictions on which products can be coordinated with others. In these cases, the primary plan cannot be coordinated with the secondary (or possibly at all). There are many instances of this. |
COB claim: VSP primary product = CVC. Secondary product = Signature. |
|
ADJINV0005 |
Service code and modifier combination is not allowed or missing |
— |
This error can occur when inventory doesn't have the specified service code/modifier combination or when the service code requires a modifier that is not available. |
For example, billing CPT code 92250 without modifier 52 would trigger this error. |
|
ADJLAB0001 |
Lab invalid for the date of service |
— |
This error occurs when the specified lab is not a VSP contract lab. |
For example, if lab IDs are 100 to 999 and you specify A001, this error would occur. |
|
ADJPRD0005 |
Patient relationship is not found for the benefit |
— |
This patient relationship is not accepted for the specified client product. |
For example, Relationship = Domestic Partner, but the client product doesn't cover domestic partners. |
|
ADJPRD0016 |
Member not covered in Product for date of service |
— |
|
|
|
ADJPRD0018 |
Easy Option upgrade not found in product |
— |
|
|
|
ADJUDI0004 |
Service must be billed with a specific diagnosis code |
|
The diagnosis code in a service bill must be from the condition list for the service. |
- When billing for 92065 or 92060 services, you must include a diagnosis code from the Vision Therapy condition list. - When billing for materials, you must include a diagnosis code from the Well Vision Materials condition list. |
|
ADJUDI0008 |
Service requires Service Verification from VSP |
— |
To include the service on a claim being submitted to VSP, you must provide a service verification number. |
Vision Therapy and Low Vision often require this. |
|
ADJUDI0020 |
Service requires a payable exam on the claim |
— |
If a claim for this service does not include a billable line item for an exam, the claim cannot be submitted for payment. |
For example, CPT codes 99199 and 92015 cannot be billed without a payable exam. |
|
ADJUDI0031 |
Service exceeds the maximum units allowed |
— |
The VSP inventory system assigns a certain number of units to each service. This error occurs when the bill for a service exceeds the maximum number of units assigned to the service.
|
For example, the inventory service assigns one unit to each exam. So if you bill two units for an exam, this error occurs. |
|
ADJUDI0033 |
Wholesale Frame Cost is required for frame material service |
— |
When a frame is submitted for reimbursement, the wholesale frame cost must be provided. |
A wholesale frame cost of $0.00 cannot be reimbursed. |
|
ADJUDI0034 |
Frame case is not payable |
— |
A frame case is not a billable item when the frame is supplied by the patient. |
When a frame is supplied by the patient, you cannot include V2756 (an HCPCS code for an eyeglass case) on the bill. |
|
ADJUDI0038 |
Lens enhancement is not allowed with the Lens Vision Type
|
— |
A lens enhancement was not billed with the correct bifocal base lens. |
To be payable, VSP codes XGA, XIA, XIB, XID, XII, and XIL must be billed with a payable bifocal lens dispensing code. |
|
ADJUDI0041 |
The diagnosis pointer is pointing to an incomplete or invalid diagnosis code |
— |
The diagnosis code is incomplete or invalid, AND it is being used as a diagnosis for a specific service line. |
For example, diagnosis Box B contains H5, and the pointer for the exam is "B." |
|
ADJUDI0042 |
The first diagnosis code on the claim is not allowed as primary |
— |
Medicaid only: Some diagnosis codes are not allowed to be billed as the primary diagnosis on a claim. |
— |
|
ADJUDI0051 |
The primary diagnosis code on the claim is incomplete or invalid |
— |
The diagnosis code is incomplete or invalid, AND it is listed as the primary diagnosis code on the claim |
For example, diagnosis Box A contains H5. |
|
ADJUDI0070 |
Service code is not allowed with other services billed |
— |
All corresponding services are denied when a contact lens, contact lens service, or both are billed with an eyeglass lens or frame on the same claim. |
You cannot bill contact lenses and eyeglasses (lens, frame, or both) on the same claim. |
|
ADJUDI0077 |
Visually necessary service. Invoice required |
— |
CA Medicaid and Low Vision: You must bill Low Vision with the KX modifier to indicate verification. |
This error occurs when the service is V2600, V2610, V2615, V2199, V2299, V2399, V2499, V2499, V2702, or V2799 and is NOT billed with the KX modifier. |
|
ADJUDI0079 |
Lens dispensing is not allowed with the lens material type |
— |
— |
— |
|
ADJUDI0081 |
Lens Vision Type does not match the billed lens Dispensing Code |
— |
Non-PIA and PIA-Denied Medicaid: The lens dispensing and lens material codes must be for the same vision type and both must be payable. "PIA" stands for Prison Industry Authority. |
For example, a claim cannot have a bifocal dispensing code and a single-vision material code. A claim must have one of each of the following CPT codes: - Dispensing: 92340 or 92352 - Lens vision type: V2100-V2199 or V2410 |
|
ADJUDI0083 |
Service lines billed exceeds the maximum allowed |
— |
NCL Medicaid: A claim cannot have more than 2 units of service. (This is also the yearly limit for a patient.) |
— |
|
ADJUDI0087 |
Lens service not allowed with modifier billed |
— |
MI Medicaid: U1 and U2 modifiers (polycarbonate and high-index) cannot be billed on the same claim line. They must also be attached to an appropriate HCPCS code. |
- V2100 codes cannot be billed with U1 and U2 modifiers. - The V2300 code cannot be billed with the U1 modifier. |
|
ADJUDI0091 |
Lab not active under the plan program on date of service |
Claim has invalid Lab Id for Participating Retail Provider. |
— |
— |
|
ELIGIB0001 |
Patient is either not found or not covered |
Patient is either not found or not covered under member policy. |
This error occurs when the patient is no longer active in VSP systems. |
— |
|
ELIGIB0002 |
Member ID on the claim doesn't match the Member ID on the Authorization |
— |
The social security number or the expanded ID on the claim is different from the one on the authorization, which means the claim and the authorization are for different patients. |
— |
|
ELIGIB0003 |
Patient on the claim doesn't match the patient on the Authorization |
Patient name, DOB, or relation on the claim doesn't match the VSR. |
The name on the claim is not the same as the name on the authorization, which means the claim and the authorization are for different patients. |
— |
|
ELIGIB0005 |
Date of service is not within the effective dates of the Authorization |
— |
Most authorizations are valid for 30 days, though they can vary. |
This error would occur in the following situation: - Authorization dates: 11/01/2020 to 11/30/2020 - Date of service: 12/01/2020 |
|
ELIGIB0008 |
Exam is not included on the Authorization |
— |
The exam is not authorized on the authorization the doctor is using. |
For example, this error would occur in these situations: - An exam is added to an authorization for frames only. - When selecting services for an authorization, you missed a service that you meant to include. |
|
ELIGIB0011 |
Authorization not found |
— |
If the authorization is deleted, this error occurs. |
— |
|
ELIGIB0013 |
Authorization has been used by another claim |
— |
The authorization has already been used to submit a claim. |
—
|
|
ELIGIB0015 |
Authorization has invalid member information |
VSR has invalid member information |
The authorization has invalid member information, such as member name, date of birth, or relationship to the insured. |
— |
|
ELIGIB0016 |
Vision Therapy Evaluation or Vision Therapy Sessions is not authorized on the VSR |
— |
The authorization is not for a product that includes Vision Therapy evaluations or sessions. |
— |
|
ELIGIB0017 |
The VSP Coordination of Benefits Secondary Authorization number you entered is not valid. Please enter a valid secondary authorization number for this patient |
The Authorization number in the COB box is not a valid authorization. |
For Coordination of Benefits (COB) claims, a different authorization number is needed for the secondary claim. This error occurs when the authorization number in the COB field matches the authorization number used for the claim. |
This error would occur in the following situation: - Claim number = 12345678 - Secondary authorization field = 12345678 |
|
ELIGIB0018 |
The VSP Coordination of Benefits Secondary Authorization number you entered is not valid. Please enter a valid secondary authorization number for this patient |
The Authorization number in the COB box is not a valid authorization. |
For COB from VSP to VSP claims, a valid authorization number is needed in the COB field. This error occurs when the secondary authorization number is not an eight-digit number. |
For example, this error would occur when the secondary authorization field = 012345678. |
|
ELIGIB0019 |
The VSP Coordination of Benefits Secondary Authorization number you entered is not valid. Please enter a valid secondary authorization number for this patient |
The Authorization number in the COB box is not a valid authorization |
For COB from VSP to VSP claims, an unused authorization is allowed only in the COB field. |
Secondary authorization status is not AU/IS (Authorized or Issued). |
|
ELIGIB0020 |
Authorization in the COB box has invalid member information |
COB Authorization has invalid member information |
The secondary authorization must have the same member ID, consumer ID, and patient as the first claim. |
— |
|
ELIGIB0021 |
The patient name on the VSP Coordination of Benefits Secondary Authorization number you have entered does not match the patient name on the primary claim |
— |
The consumer ID must be the same for the patient on the first and second authorizations. |
— |
|
ELIGIB0022 |
The Date of Service must be within the effective date of the secondary Authorization effective date and the expiration date (secondary Authorization expiration date) for VSP Coordination of Benefits Secondary Authorization number |
— |
For COB from VSP to VSP claims, this error occurs when the date of service is not within the secondary authorization effective dates. |
This error would occur in this situation: - Authorization dates: 11/01/2020 to 11/30/2020 - Date of service: 12/01/2020 |
|
OFFEXP0002 |
Please indicate whether the patient has any health conditions or confirm 'None' |
— |
If a claim includes an exam, the exam must specify whether the patient has any health conditions. |
In any exam listed on a claim, one or more of the following health conditions must be selected: - Diabetes - Diabetic retinopathy - Hypertension - High cholesterol - Prediabetes If the patient has no known health conditions, select None. |
|
OFFEXP0003 |
Please indicate whether or not dilation has been performed |
— |
If diabetes or diabetic retinopathy is selected as a known health condition in an exam, the exam must specify whether a dilation was performed. |
— |
|
OFFEXP0004 |
You have Duplicate Diagnosis codes. Diagnosis codes may be entered only once |
— |
The same diagnosis code was entered more than once in Box 21 of a CMS 1500 form. |
For example, both Box A and Box have H52.4. |
|
OFFEXP0005 |
You must accept assignment to submit the claim |
— |
In Box 27 (Accept Assignment) of the CMS 1500 form, the Yes check box must be selected. If it is not, this error occurs. |
— |
|
OFFEXP0006 |
Patient Paid amount must be equal to or less than the Total Charges |
— |
In the CMS 1500 form, Box 28 (Total Charge) cannot be less than Box 29 (Amount Paid). If the patient paid more than the total due, this error occurs.
|
The following amounts would trigger this error: - Total due: $250 - Patient paid: $300 |
|
OFFEXP0007 |
You have entered Duplicate Diagnosis Pointers. Diagnosis Pointers may be entered only once |
— |
One claim line has the same diagnosis pointer multiple times. |
For example, pointer A appears twice in the claim line for V2020. |
|
OFFEXP0009 |
Please enter a valid Diagnosis Pointer |
— |
A diagnosis pointer that is not pointer A–L is entered on a service line. |
For example, pointer M appears in a claim line. |
|
OFFEXP0010 |
Please specify a contact lens brand |
— |
Contact lens materials are billed, but a brand is not provided. |
— |
|
OFFEXP0012 |
The prescription information you have entered does not meet VSP minimum prescription requirements for the benefit selected. For information regarding VSP minimum prescription requirements please see the VSP Provider Reference Manual or call VSP |
— |
In a prescription, lenses must be plano or meet the VSP minimum criteria. |
VSP minimum prescription criteria: The combined power in any meridian is ±0.50 diopters or greater in at least one eye, OR one of the following exceptions occurs: - A necessary prism of 0.50 diopters or greater in at least one eye. - Anisometropia is 0.50 diopters or greater. - Cylinder power is ±0.50 diopters or greater. |
|
OFFEXP0017 |
This claim includes more than 15 Service Lines. If all information is accurate please split services between multiple claims for submission |
— |
Because of system limitations, a claim cannot have more than 15 service line items. |
— |
|
OFFEXP0018 |
The Frame Supplier is required |
— |
A frame supplier is required if either of the following occurs: - A lens service is used (one or more lenses are billed) - A frame service is used (a frame is billed) Select one of the following frame suppliers: - Doctor Supplied – To Come - Patient Supplied – To Come - Lab Supplied - Lenses Only The lens supplier is specified in the Lens Finishing field. Select one of the following options: - Lab Finishing - In-Office Finishing |
— |
|
OFFEXP0019 |
Supplier cannot be Lenses Only if a lens service has not been selected |
— |
If lenses are not ordered, you cannot use a lens-only supplier. |
— |
|
OFFEXP0020 |
Supplier cannot be Doctor or Lab if a frame service has not been selected |
— |
If a frame is not billed, the frame cannot be supplied by a doctor or a lab because no frame is being dispensed. In this case, the only options for frame supplier are the following: - Patient Supplied - To Come - Lenses Only |
— |
|
OFFEXP0021 |
Based on the information provided on this claim, this patient is not eligible for the necessary contact lenses you have selected. Please refer to the Provider Reference Manual for necessary contact lens coverage limitations and instructions |
— |
Necessary contact lenses (NCL) is a service (product item) attached to the VSP coverage (product) that the patient has for her benefits. It is not Medicaid. There is no service verification number, the diagnosis code is not in the NCL condition group, and the prescription does not meet the NCL minimum. |
— |
|
OFFEXP0025 |
Based on the information provided on this claim this patient is not eligible for the necessary contact lenses you have selected. Please refer to the Provider Reference Manual for necessary contact lens coverage limitations and instructions |
— |
If all of the following conditions are met on a Medicaid claim, this error occurs: - The claim is for a Medicaid product. - NCL is a product item (service) under the client's Medicaid coverage. - The service line does not contain the KX modifier. |
— |
|
OFFEXP0027 |
Please indicate if communication with Patient's PCP is planned |
— |
If diabetes or diabetic retinopathy is listed as a known condition, you must specify whether the office intends to communicate with the patient's primary care physician (PCP). |
— |
|
OFFEXP0028 |
Patient FSA amount must be greater than or equal to patient paid amount |
— |
The amount deducted from the patient's flexible spending account (FSA) cannot be greater than the total amount the patient paid. |
The following situation would trigger this error: - FSA paid $250 - Patient paid $200 |
|
OFFEXP0031 |
In-office lens finishing is not available for this order |
— |
The office, the product, or both do not meet the requirements for in-office finishing (IOF) lenses. |
For example, if the primary product is not Signature, Choice, or Advantage, this error would be triggered. |
|
OFFEXP0032 |
Client is not set up for Flexible Spending Account. Please remove FSA Paid Amount |
— |
This error occurs when a client does not have an FSA set up but an FSA paid amount is entered. |
— |
|
OFFEXP0036 |
Please enter a valid Patient First and Last name |
— |
The patient's name is missing from the claim or has invalid characters. |
The following characters are allowed in patient names. Any others trigger this error. - All the letters in the English alphabet - Apostrophes - Hyphens (must be followed by a letter) - Periods - Spaces |
|
OFFEXP0037 |
Please enter a valid Middle Initial for the Patient |
— |
The middle Initial must be a single letter on the claim. |
— |
|
OFFEXP0038 |
Please enter a valid Patient Date of Birth |
— |
The date of birth (DOB) is missing from the claim. |
— |
|
OFFEXP0039 |
Please enter a valid Insured First and Last name. |
— |
The insured's name is missing from the claim or has invalid characters. |
The following characters are allowed in names of the insured. Any others trigger this error. - All the letters in the English alphabet - Apostrophes - Hyphens (must be followed by a letter) - Periods - Spaces |
|
OFFEXP0040 |
Please enter a valid Middle Initial for the member. |
— |
The middle Initial must be a single letter on the claim. |
— |
|
OFFEXP0041 |
Please enter a valid Insured Date of Birth. |
— |
The date of birth (DOB) is missing from the claim. |
— |
|
OFFEXP0042 |
Please enter a valid address |
— |
The address is missing from the claim, is too long, or contains invalid characters. |
Address: Cannot be over 30 characters. Use only letters, numbers, periods, dashes, spaces, slashes, commas, hash signs (#), ampersands (&). City: Cannot be over 25 characters. Use only letters, numbers, periods, dashes, spaces, slashes, commas, hash signs (#), ampersands (&). State: Use a valid 2-character state code Zip code: Cannot be over 5 characters (plus 4 for the extension). Use only numbers. Do not use an extension without a zip code. |
|
OFFEXP0043 |
Please enter a valid Phone Number |
— |
The phone number on the claim is invalid. |
This error has various triggers, such as the following: - Does not have an area code - Has only an area code - Does not contain only numbers |
|
OFFEXP0044 |
Please enter a valid First and Last name of Referring Provider
|
— |
If the national provider identifier (NPI) of a referring doctor is entered on the claim, the referring doctor's name must also be entered on the claim. |
Use only valid characters: - All the letters in the English alphabet - Apostrophes - Hyphens (must be followed by a letter) - Periods - Spaces |
|
OFFEXP0045 |
Please enter a valid NPI for Referring Provider |
— |
If the name of a referring doctor is entered on the claim, the referring NPI cannot be blank. |
—
|
|
OFFEXP0046 |
Please enter a valid Middle Initial of Referring Provider |
— |
The middle initial must be a single letter only on the claim. |
— |
|
OFFEXP0047 |
Please enter a valid Other Insured First and Last Name |
— |
If any "Other Insurance" information is entered on the claim, the subscriber's first and last name must be entered and valid. |
Use only valid characters: - All the letters in the English alphabet - Apostrophes - Hyphens (must be followed by a letter) - Periods - Spaces |
|
OFFEXP0048 |
Please enter a valid Other Insured Policy or Group Number |
— |
If any "Other Insurance" information is entered on the claim, the policy or group number must be entered in Box 9a (Other Insured's Policy or Group Number) of the CMS 1500 form, and it must be valid. |
The policy or group number is alphanumeric. |
|
OFFEXP0049 |
Please enter a valid Plan Name or Program Name |
— |
If any "Other Insurance" information is entered on the claim, the plan or program name must be entered in Box 9d (Insurance Plan Name or Program Name) of the CMS 1500 form, and it must be valid. |
Use only valid characters: - All the letters in the English alphabet - Apostrophes - Hyphens (must be followed by a letter) - Periods - Spaces |
|
OFFEXP0050 |
Another health benefit plan must be marked “Yes” when secondary insurance information is present |
— |
If any "Other Insurance" information is entered on the claim, the system is programmed to mark Box 11d (Is There Another Health Benefit Plan?) of the CMS 1500 form Yes. |
— |
|
OFFEXP0051 |
Please enter a valid Patient Account Number |
— |
Must be valid if provided on the claim. |
Use only valid characters: - All the letters in the English alphabet - Apostrophes - Commas - Hyphens (must be followed by a letter) - Numbers - Periods - Spaces |
|
OFFEXP0052 |
Invalid character entered in Box 19 Additional Claim Information |
— |
Must be valid if provided on the claim. |
Use only valid characters: - All the letters in the English alphabet - Numbers - Spaces - The following special characters: . ! @ # $ % & * ( ) + - < > , { } [ ] / ? |
|
OFFEXP0053 |
A valid state code is required when patients condition relates to Auto Accident |
— |
If Box 10b (Related to Auto Accident) on the CMS 1500 form is Yes, a valid two-character state code must be included. |
— |
|
OFFEXP0054 |
Please select one option for patient Health Coverage |
— |
The patient's health insurance coverage must be specified in the claim. Check the appropriate healthcare coverage in Box 1 on the CMS 1500 form. |
Typically, this defaults to Group Health Plan. |
|
OFFEXP0055 |
Please enter a valid Insured Middle Initial |
— |
The middle initial must be a single letter on the claim. |
— |
|
OFFEXP0056 |
Please enter a valid Medicaid Resubmission Code |
— |
This is required if an Original Reference Number (Box 22 on the CMS 1500 form) is specified. It must be valid if provided. |
The code must be alphanumeric and contain no more than 11 characters. |
|
OFFEXP0057 |
Please enter a Valid Original Ref. No |
— |
This is required if a Resubmission Code (Box 22 on the CMS 1500 form) is specified. It must be valid if provided. |
This "number" must be alphanumeric and contain no more than 18 characters. |
|
OFFEXP0058 |
Please enter a valid Policy or FECA Number |
— |
Must be valid if provided on the claim. |
Must be alphanumeric. |
|
OFFEXP0059 |
Please enter a valid Plan or Program Name |
— |
Must be valid if provided on the claim. |
Use only valid characters: - All the letters in the English alphabet - Apostrophes - Commas - Hyphens (must be followed by a letter) - Numbers - Periods - Spaces |
|
OFFEXP0060 |
The Patient Unable to Work To Date cannot be less than the From Date |
— |
If Box 16 on the CMS 1500 form is Yes, the required From date cannot be later than the To date. |
For example, do not use these dates: - From: 11/01/2020 - To: 10/01/2020 |
|
OFFEXP0061 |
The Hospitalization To Date cannot be less than the From Date |
— |
If Box 18 on the CMS 1500 form is Yes, the required From date cannot be later than the To date. |
For example, do not use these dates: - From: 11/01/2020 - To: 10/01/2020 |
|
OFFEXP0062 |
Contact Lens Brand contains an invalid character |
— |
Must be valid if provided. |
Valid characters are letters, numbers, hyphens (–), parentheses ( ), ampersands (&), and percent signs (%). |
|
OFFEXP0064 |
The selected lens cannot be ordered without an Optical Center Height or Segment Height value |
— |
Some lenses have a technical add-on attribute that requires these measurements to be added. |
Many lenses have this attribute. For example, see Zeiss Digital 1000 - Clear. |
|
OFFEXP0065 |
Unity Lens cannot be ordered with an Essilor AR coating |
— |
This is the manufacturer's restriction. |
— |
|
OFFEXP0066 |
Slab Off is not available for this lens product |
— |
If a lens has a custom measurement option (V2702, VSP Code CM, or both), slab off cannot be used on the lens. |
— |
|
OFFEXP0067 |
This lens is not available for this type of order |
— |
This error occurs when a lens is not part of the eClaim channel. |
For example, see Lenton&Rusby 18 w/L&R Premium Coating - L&R Photochromic Gray. |
|
OFFEXP0068 |
The Anti-reflective coating you selected is already included in the lens you selected from the lens list |
— |
When anti-reflection is an inherent part of a lens, it cannot be added separately. |
For example, see Crizal Prevencia. |
|
OFFEXP0069 |
Ethos Lens cannot be ordered with an Essilor AR coating |
— |
This is the manufacturer's restriction. |
— |
|
OFFEXP0070 |
Lab is invalid for claims where VSP is not the Primary payer |
— |
When VSP is not the primary payer on a claim, the claim can be sent only to lab ID 100, which signifies an independent lab that is not part of the VSP Contract Lab Network. |
— |
|
OFFEXP0071 |
A Maui Jim Sun Frame requires a Maui Jim lens to be selected |
— |
A Maui Jim Sun frame must have a Maui Jim lens. |
— |
|
OFFEXP0072 |
Please select the Rx option of this frame. A Maui Jim Plano Sun Frame cannot be billed with a prescription Lens |
— |
When prescription lenses are billed, a Maui Jim frame must be compatible with the lenses. The frame cannot be approved only for plano. |
— |
|
OFFEXP0073 |
A ProTec Eyeware frame is required. For frame choices refer to the ProTec Eyewear kit or online catalog |
— |
For ProTec products whose frame is supplied by a doctor or a lab, you must choose an approved ProTec frame. |
— |
|
OFFEXP0074
|
A VSP or Generic lens must be selected for Charity claims |
— |
VSP charity orders must have a generic or VSP-branded lens. |
This applies to claims from Eyes of Hope gift certificates. |
|
OFFEXP0075 |
A VSP or Generic AR coating must be selected for Charity claims |
— |
VSP charity orders must have a generic or VSP-branded anti-reflective coating. |
This applies to claims from Eyes of Hope gift certificates. |
|
OFFEXP0078 |
Address cannot be more than 30 characters |
— |
This is the system limitation for the length of the Address field. |
— |
|
OFFEXP0079 |
City cannot be more than 25 characters |
— |
This is the system limitation for the length of the City field. |
— |
|
OFFHDR1001 |
Diagnosis code billed is not allowed for the service code |
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The diagnosis code is incompatible with the service code. |
For example, this error would occur if you included the diagnosis code Z01.00 (which covers eye exams) in a claim for materials only. |
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OFFHDR1002 |
Lens finishing code on the claim is not allowed with the lens material code billed on the claim |
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The lens finishing and lens material are not a valid combination. |
For example, you cannot include stock lenses and glass on a claim. |
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OFFHDR1003 |
Lens enhancement VSP service code is not allowed with the lens type billed on the claim |
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Some VSP material codes require specified vision types. |
For example, multifocal code must be applied only to a multifocal lens, such as bifocal or progressive. |
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OFFHDR1004 |
Contact Lens reason type is not allowed for the service code |
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This error occurs when the contact lens reason is elective (ECL) and any contact lens fitting code (92070, 92072, 92313, 92314, 92315, 92316, 92317, 92325) is included in the claim. |
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OFFHDR2001 |
Product item requires a specific lab for processing, and corresponding lab network service not indicated |
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The lab network specified in the product does not match the lab network for the selected (billed) lab. |
For example, the lab does not participate in CHOIC, but he product's lab network for billed services is CHOIC. |
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OFFHDR2004 |
Lens Enhancement is not payable due to a not allowed service being billed |
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Some clients do not allow specified enhancements. This is sometimes tied to specific product packages, such as Computer Vision Care (CVC). The entire lens and frame order is denied. |
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OFFHDR2005 |
Lens Enhancement is not an allowed benefit for the patient |
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Some clients do not allow specified enhancements. This is sometimes tied to specific product packages, such as CVC. The enhancement is denied. |
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OFFHDR2007 |
The wholesale frame amount is required for frame material service |
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This error occurs when the billed amount for the VSP material code MF is $0.00. The error does not apply when the frame is supplied by a lab and an in-kit frame collection is used. |
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OFFHDR2008 |
Lens enhancement is not allowed with the lens material type |
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To be payable, the VSP material codes XGA, XIA, XIB, XID, XII, and XIL must be billed with a payable bifocal lens dispensing code. |
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OFFHDR2010 |
Lens enhancement code is not allowed with the other lens enhancement codes billed with the same type |
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A claim cannot use two different VSP material codes to bill for the same enhancement. |
For example, using the material codes XFH and XAB in the same claim triggers this error because both codes apply to hi-index lenses. |
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OFFHDR2011 |
Service code not allowed to be billed with In-Office Finishing Stock Lens |
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Some enhancements cannot be included in an in-office finishing (IOF) claim. |
For example, polycarbonate lenses and anti-reflective coatings cannot be included in IOF claims. |
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OFFHDR2013 |
Accompanying lens enhancement was not billed |
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Per an inventory include requirement, the claim cannot bill for the lens enhancement because it is required for another enhancement in the claim or for the base lens. |
For example, a claim for V2782 JB - Mid-Index Plastic 1.53-1.60/Trive x (Progressive J add-on) cannot include V2781 JA - Progressive J Plastic. |
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OFFHDR2014 |
Glass lens enhancement code is not allowed with a non-glass lens enhancement code |
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A claim cannot include both a glass lens enhancement code and a nonglass lens enhancement code. |
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OFFHDR2015 |
Service billed is not covered for Elective Contact Lenses |
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Under the well-vision benefit, some CPT codes for exam fitting and evaluation can be billed with necessary contact lenses (NCL) but not with elective contact lenses (ECL). This includes 92072 and 92313. |
For example, while billing for contact lenses, if you select elective as the contact type and 92072 as the fitting code, this error will occur. |
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OFFHDR2016 |
Lens materials not covered under PIA |
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CA Medicaid: California Medicaid cannot pay for lenses and lens enhancements if the lab is PIA (Prison Industry Authority). |
For example, sending a California Medicaid claim to lab 999 (Folsom) will trigger this error. |
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OFFHDR2017 |
Invalid lab selected for In-Office Finishing (Uncut) |
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Uncut lenses are limited to VSPOne locations. |
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OFFHDR2018 |
Invalid lab selected for In-Office Finishing (Stock) |
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Stock lenses are available for single-vision lenses only and must use lab 557. |
If you select stock for single-vision lenses and choose a lab other than 557, this error occurs. |
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OFFHDR2019 |
Lab used does not belong to participating labs defined under the program |
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Lab 199 or 999 is required for ProTec and other safety products. |
If a lab other than 199 or 999 is selected for a ProTec product, this error occurs. |
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OFFHDR2020 |
Invalid Lab selected for the benefit |
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Claims for an Elements product must go to lab 199 (Columbus). |
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OFFHDR2021 |
Lens service code is not allowed with other services billed |
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MI Medicaid: A claim for lenses cannot include a frame repair. |
Claims for 92310–92353, 92396, V2100–V2599, V2700–V2799, V2020, and S0581 cannot include codes 92370 or 92371, which are for repairing spectacles. |
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OFFHDR2022 |
Wholesale Frame cost cannot be greater than or equal to the V2020 or V2025 Retail Frame Amount |
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You cannot bill a patient less than or the same amount as the wholesale cost of a frame. |
For example, the following situation would trigger this error: - Retail charge (billed to patient): $25.00 Wholesale frame cost: $50.00 |
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OFFHDR2023 |
Reason for an emergency visit is missing in claim Box 19 |
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ProTec and other safety products must use specific labs. In an emergency, they can use a private lab, but you must specify the reason for the emergency in Box 19 of the CMS 1500 form. |
- For example, this error would occur if you bill a ProTec product to lab ID 100 (an independent lab that is not part of the VSP Contract Lab Network) with a frame on the claim and leave Box 19 empty. |
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OFFHDR2024 |
HCFA Box 19 must contain "PIA Denied" |
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CA Medicaid: If a non-PIA (Prison Industry Authority) lab is used, Box 19 of the CMS 1500 form must contain this text: PIA Denied |
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OFFHDR2025 |
The claim was submitted beyond the allowed submission period |
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The claim was submitted after the filing period ended. For most clients, the period is six months. |
For example, this error would occur if you submitted a claim with a date of service (DOS) that is more than 180 days earlier than the date of submission. |
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OFFHDR3001 |
Frame is not authorized on the Authorization |
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The frame is not authorized on the authorization the doctor is using. |
For example, this error would occur if a user issued an authorization for selected services but billed for others when a patient changed his mind about getting a frame. |
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OFFHDR3002 |
Lens is not authorized on the Authorization |
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The lens is not authorized on the authorization the doctor is using. |
See OFFHDR3001. |
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OFFHDR3003 |
Contact Lens is not authorized on the Authorization |
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The contact lenses are not authorized on the authorization the doctor is using. |
See OFFHDR3001. |
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OFFHDR3004 |
Contact Lens Exam is not authorized on the Authorization |
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The contact lens exam is not authorized on the authorization the doctor is using. |
See OFFHDR3001. |
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OFFHDR4002 |
Service is not payable when frame is not supplied by the patient |
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The VSP code (FX) is payable only when the frame is supplied by the patient. |
If a frame is supplied by a doctor, an FX line item is not payable. Instead, use an MF line item. |
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OFFHDR4004 |
VSP contract labs are not allowed for Proprietary Lens and/or Frame orders |
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Proprietary lenses must go to lab ID 100, which signifies an independent lab that is not part of the VSP Contract Lab Network. |
For example, Maui Jim must go to a Maui Jim lab, not a VSP lab. |
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OFFHDR4005 |
Stock or uncut lenses are not allowed for Proprietary Lens orders |
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Proprietary lens orders cannot use stock or uncut lenses supplied by a lab. |
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OFFHDR4006 |
For qualifying Proprietary Lens claims with a frame, the frame must be supplied by doctor |
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Proprietary frames must be supplied by the doctor. They cannot be supplied by the patient or the lab. |
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OFFHDR4007 |
In-kit frames should be lab supplied |
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VSP Elements In-Kit frames (Otis & Piper) must be supplied by a lab. |
Selecting an Otis & Piper frame in an Elements product and then setting the frame supplier to doctor would trigger this error. |
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OFFHDR4008 |
Different lens materials are not allowed on the same claim |
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Including a single-vision lens and a multifocal lens in the same claim would trigger this error. |
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OFFHDR4009 |
The frame supplier code is invalid for Lab ID |
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Frame supplier is not one of the four options for the Frame Supplier field. |
These are the valid frame supplier options: - Doctor Supplied - Lab Supplied - Patient Supplied - Lens Only * * Use Lens Only when the patient supplies the frame. This indicates that the lab needs pertinent information about the frames (for example, size and shape) and that the office will insert the lenses into the frame. |
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OFFHDR4010 |
The frame supplier code is invalid for stock or uncut lenses |
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Stock or uncut in-house finishing (IOF) frames cannot be supplied by a lab. |
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OFFHDR4011 |
Lab ID is invalid |
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This error occurs if materials are billed and the Lab ID field is blank or invalid. |
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OFFHDR4012 |
Contact lens number of boxes is required |
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When ordering contact lenses, you must specify the number of boxes to order. |
Selecting contacts and leaving the number of boxes blank would trigger this error. |
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OFFHDR4013 |
Contact lens modality is required |
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The client requires that you specify the wear schedule (modality) for contacts and has different coverages or allowances (such as single-use, weekly, or monthly). |
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| PATENC0009 |
A problem was encountered processing your request. Please try again. If you are still experiencing a problem, check back at a later time. |
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An error occurred and the system can't identify the reason. It may be a temporary problem. If it persists, contact VSP. |
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| PATENC0020 |
The Authorization Number you have entered is not valid for this date of service |
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Try deleting the authorization and pulling a new one. |
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| PATENC0038 |
A problem was encountered %s your request. Your data was unable to be saved. Please try again later. |
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Your request couldn't be saved. It may be a temporary problem. If it persists, contact VSP. |
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| PATENC0039 | A problem was encountered in verifying the data. | — |
This error can have several difference causes. Contact Eyefinity Customer Care at 800.942.5353 to resolve. |
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| PATENC0045 |
A problem was encountered processing your request. Please try again. If you are still experiencing a problem, check back at a later time. |
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An error occurred and the system can't identify the reason. It may be a temporary problem. If it persists, contact VSP. |
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PRELIQ0001 |
A valid member's ID is required |
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This occurs only if your system is set up to require a member or consumer ID. Note: A consumer ID is an internal identification number. Users never enter the consumer ID. |
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PRELIQ0002 |
Patient's first and/or last name is missing. |
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Patient's full name is required. |
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PRELIQ0003 |
A valid patient date of birth is required |
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Patient's date of birth is required and must be valid. |
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PRELIQ0004 |
Insured name is required |
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Insured member's name is required. |
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PRELIQ0005 |
Patient relationship is required |
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Specify how the patient is related to the insurance subscriber. |
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PRELIQ0006 |
The date of service is missing |
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The date the service was performed is required and must be valid. |
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PRELIQ0007 |
Service End Date is prior to Date of Service |
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If the service spans multiple days, the end date cannot be earlier than the date of service. |
The following dates would trigger this error: - Date of service = 11/01/2020 - Start date = 10/30/2020 - End date = 10/31/2020 |
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PRELIQ0008 |
Service code is required |
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At least one HCPCS/CPT code must be billed. |
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PRELIQ0009 |
Billed amount must be greater than or equal to zero |
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The billed amount for a service cannot be blank or negative. |
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PRELIQ0010 |
Payment Arrangement ID field is invalid |
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The tax ID is not valid. |
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PRELIQ0011 |
Rendering provider signature is required |
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The signature of the person who provided the service is required. |
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PRELIQ0012 |
Diagnosis code is required |
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At least one diagnosis code must be provided. |
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PRELIQ0013 |
All diagnosis codes are invalid |
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At least one diagnosis code must be valid. |
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PRELIQ0017 |
Contact Lens Reason Code is required |
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If contact lenses are billed, the contact lens reason code must be specified: - ECL (elective contact lens) - NCL (necessary contact lens) |
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PRELIQ0025 |
Date of service cannot be a future date |
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PRELIQ0026 |
Contact Lens Type is not valid for the benefit |
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The contact lens type (HCPCS/CPT code) is not valid. |
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PRELIQ0029 |
Service is not payable when frame is supplied by patient or blank |
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A frame supplied by the patient is not payable. |
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PRELIQ0033 |
Rendering provider's NPI is not found or is invalid |
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The National Provider Identifier (NPI) must be a valid 10-digit number that belongs to an active provider in the VSP system. |
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PRELIQ0034 |
Unit count is invalid |
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Units cannot be less than or equal to 0 on a service line item. |
For example, you cannot enter a 92004 service and bill 0 units. |
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PRELIQ0040 |
Invalid place of service for date of service |
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A place-of-service code must be in the table of acceptable codes and be active on the date of service. Typically, the code is 11 (Office). For the complete list, see Place of Service Code Set. VSP does not accept all the codes in the list. |
Telehealth claims submitted now with a date of service before 2020 would trigger this error. |
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PRELIQ0041 |
Lens style is required |
Stock Lens must be submitted electronically |
Contact lens stock orders must be submitted electronically. Note: Since you are working in an electronic system, you should not encounter this error. |
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PRELIQ0048 |
Patient Sex is required |
Patient gender is required |
Patient's gender is required. |
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PRELIQ0049 |
Patient address is required |
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PRELIQ0051 |
A valid billing provider name and address is required |
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PRELIQ0053 |
At least one diagnosis pointer must point to a valid diagnosis code |
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Each service line must have a valid diagnosis pointer referencing a valid diagnosis code . |
For example, to prevent an error, you must have the following: - Valid diagnosis codes in boxes A–C - An A–C pointer in each line |
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PRELIQ0056 |
You have entered duplicate diagnosis codes. Diagnosis codes may be entered only once |
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The same diagnosis code was entered more than once in the CMS 1500 form or the claim. Each diagnosis code can appear only once on a claim. |
The following situation would trigger this error: Both Box A and Box B contain diagnosis code H52.4. |
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PRELIQ0059 |
An authorization number is required to submit a claim |
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This error is unlikely to occur because most VSP electronic systems require an authorization number to begin a claim, let alone to submit one. |
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PRELIQ0063 |
Please indicate Signature on File |
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You must have the patient's signature on file. See Box 12 of the CMS 1500 form. |
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PRELIQ0064 |
Patient Signature Date is required and cannot be a future date |
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The date the patient provided her signature must be entered in Box 12 of the CMS 1500 form. |
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PRELIQ0065 |
Place of service address is required |
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In Box 32 of the CMS 1500 form, enter the name and address of the facility where services were rendered. |
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PRELIQ0066 |
ID Number of Referring Physician - Invalid check digit |
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Eyefinity Practice Management validates that the National Provider Identifier (NPI) is a valid ID, not just any 10-digit number. |
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PRELIQ0068 |
Service Verification may only be billed with NCL. Please change the lens reason from ECL to NCL or remove Service Verification |
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Service verification cannot be billed for elective contacts (ECL), only for medically necessary contacts (NCL). |
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PRELIQ0070 |
Please enter the number of boxes (1-99) |
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This error occurs when contacts are selected and the number of boxes is not specified. |
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PRELIQ0071 |
Please enter a valid number of boxes(1-99) |
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This error occurs when contacts are selected and the number of boxes is not a one- or two-digit number. |
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