Warnings and Errors in the VSP Interface

Service code is invalid

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The service code is not valid for the specified product.

Service code is not valid for the date of service

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On the date of service (DOS), the billed code is not active.

Service code is not allowed

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The billed service is not covered under the product.

An internal error has occurred and some services may not be validated, click OK to continue

Unable to complete validation for the service code due to an internal system error. The product catalog does not exists for the Inventory Item.

There is a problem with the plan. If you receive this warning, contact VSP.

Services billed are not payable under this benefit

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When a service is not listed as a covered benefit in the client's product catalog, this warning appears.

An internal error has occurred and some services may not be validated, click OK to continue

Provider network is not allowed for patient's benefit

The member is not in the correct network to visit this doctor. This should be extremely rare because an authorization should not be issued in such situations.

Service is not found for patient's benefit

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A product package is not defined in the product. This is a data issue on the VSP side.

If you systematically hide this warning from doctors, you run a high risk that the problem will continue.

If you receive this warning, contact VSP.

Service not covered

Service not covered because of lens design and lens vision type.

The service is not covered because of incompatiblelens design and lens vision type.

This error should rarely occur because the system is designed to determine the correct codes by looking at the prescription.

Service not covered without Service Verification

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The service is not covered because the service verification requirement was not fulfilled.

Chosen Dye options not covered for this service

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The lens color and absorption level are not covered for the service.

Service not covered

Service not covered due to another service billed or missing.

When a service is not covered because of an include/exclude rule, this warning appears.

Service not covered because of material manufacturer

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The manufacturer of the selected frame is not covered by the patient's product.

Chosen Frame Collection not covered for this service

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The selected frame is part of a collection that is not covered by the patient's product.

Chosen Frame Brand not covered for this service

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The brand of the selected frame is not covered by the patient's product.

Chosen Contact Lens Modality not covered for this service

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The modality (contact lens wear schedule, such as weekly or daily) chosen by a doctor is not covered, a rare but possible problem.

Contact Lens Frequency has been exceeded

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The patient's product does not cover the frequency of service (how often contact lenses are supplied) prescribed by the doctor.

An internal error has occurred and some services may not be validated, click OK to continue

Multiple product items found.

This generic warning is triggered when multiple coverage constraints are found for the same product item. This is a data issue on the VSP side.

If you receive this warning, contact VSP.

An internal error has occurred and some services may not be validated, click OK to continue

System unable to complete validation due to internal system error.

This is a data issue on the VSP side.

If you receive this warning, contact VSP.

An internal error has occurred and some services may not be validated, click OK to continue

Level of coverage in Product is missing for the service code.

The level of coverage is not specified.

If you receive this warning, contact VSP.

An internal error has occurred and some services may not be validated, click OK to continue

System unable to complete validation due to internal system error.

This is a data issue on the VSP side.

If you receive this warning, contact VSP.

ADJUDI0001

Dependent service is not payable

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This occurs when two related services must be paid together but cannot because the primary service is not on the claim or is not payable for some reason other than eligibility.

ADJUDI0002

Units of service exceeds maximum units allowed

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If the amount of a service or materials that a patient can receive is restricted, this warning appears when the patient exceeds the limit.

ADJUDI0003

An internal error has occurred and some services may not be validated, click OK to continue

An unexpected exception occurred when retrieving dependencies

This occurs in the client API on the VSP side. The user cannot correct it.

If you receive this warning, contact VSP.

ADJUDI0018

Frame service is not payable

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This occurs when you use a V2020 or V2025 CPT code and the Internal VSP MF code is missing. The user cannot add the missing code.

ADJUDI0019

Patient supplied frame is indicated. Frame dispensing HCPCS not allowed

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You cannot include a V2020 or V2025 CPT code in a claim with a patient-supplied frame.

ADJUDI0021

Frame billed amount exceeds frame wholesale allowance

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The wholesale cost of a frame is greater than the wholesale allowance on a patient's coverage. This is not the retail amount billed to the patient.

Service is not payable due to related service not payable on the claim

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If you submit a claim for in-office finishing (IOF), it will be denied if either the MLK or V21**, V22**, or V23** base lens code is not payable.

Service is included in the exam service payable on the claim

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Refraction is not separately payable because it is covered by the exam code.

Service code is not covered for the benefit

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When the level of coverage is "Not Covered," this warning appears on the appropriate line.

ADJUDI0035

Frame manufacturer is not covered

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When an unapproved frame is billed, this warning appears.

Lens enhancements billed are included in the lens reimbursement for Lab ID 100

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Deny VSP option codes if the lab ID is 100 and a VSP contract lab is specified in the product.

Service code is only payable once per claim

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If more than one VSP material code is billed for the same service, this warning appears.

Lens style is required

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Lens style is a required field in POS and Front Office. An order cannot be completed unless it contains this information.

Service is not payable due to a related service that is denied or not billed on the claim

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The service is not payable because a related service was denied.

Service is included in another service payable on the claim

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This is a roll-up warning for bundled items.

Service verification will be reviewed by a processor

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Some services require service verification. This warning informs the user that a processor will be reviewing the claim.

Reason for an emergency visit in claim Box 19 will be reviewed by a processor

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ProTec products require a particular lab and frame supplier. Lab 100, which signifies an independent lab that is not part of the VSP Contract Lab Network, is used for emergencies only.

The claim was submitted beyond the allowed submission period

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The claim was submitted after the timely filing period. For most clients, the filing period is 6 months (or 180 days).

Claims filed outside of that period must be submitted on paper; they cannot be submitted electronically.

Frame service code is not allowed with other services billed

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This applies only to Medicaid New York.

Service will be priced from the invoice by a processor

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This warning applies to access indemnity products with a shared allowance.

I understand that payment and satisfaction of this claim will be from federal and state funds, and that any false claims, statements, documents or concealment of a material fact, may be prosecuted under applicable federal and/or state laws

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LA Medicaid: This is a Louisiana Medicaid informational warning for explanation of payment (EOP) or explanation of benefits (EOB) messages.

An internal error has occurred and some services may not be validated, click OK to continue

Claim Validation dependent data not found. The Claim Message ID was not found.

When a search for a message returns no results, the claim is suspended with the error codes listed in the next column.

This is a data issue on the VSP side.

If you receive this warning, contact VSP.

ELIGIB0004

Authorization has an invalid status

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The status should be Issued, Authorized, or Duplicate.

Please indicate whether or not refraction has been performed

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If a 92*** exam code is billed without a 92015 refraction code, this warning appears.

S0620 and S0621 include refraction, so this warning does not apply to them.

The diagnosis code entered is not related to vision care. Do you wish to continue?

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The diagnosis code is not for vision issues.

Please indicate the Contact Lens Manufacturer

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A contact lens manufacturer is not on the claim when contacts are billed.

Diagnosis code billed is not allowed for the service code. Do you want to continue?

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The diagnosis code does not match the services on the claim.

You have requested a Horizontal Prism in only one eye. Do you want to continue?

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In the Rx information, only the right or left eye has a horizontal prism value. That's rare, so we provide a warning.

You have requested a Vertical Prism in only one eye. Do you want to continue?

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In the Rx information, only the right or left eye has a vertical prism value. That's rare, so we provide a warning.

Important! Frame only claims will be denied if they do not meet VSP's criteria. Please refer to the 'Providing Frames' section of the eManuals for more info

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This warning appears in any frame-only claim. Because frames on their own are not typically covered, this alerts the user that she should check to ensure the patient has frame-only benefits. If the patient does not, the claim will be denied.

This claim has passed VSP's diagnostic criteria for necessary contact lenses. No additional pre-certification by VSP is required

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This warning tells users that they should not bill a patient for these necessary contact lens (NCL) services because they're covered.

This claim has passed VSP's diagnostic criteria for vision therapy. No additional pre-certification by VSP is required

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This warning tells users that they should not bill a patient for these Vision Therapy services because they're covered.

The polycarbonate option will be covered in full due to the patient's monocular diagnosis. This patient should not be charged for the polycarbonate option

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This informational warning tells users that they should not bill a patient for the polycarbonate enhancement because it's covered.

You have requested opposite signs on this prescription. Do you want to continue?

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In the Rx information, the right and left eyes have different +/- signs. That's rare, so we provide a warning.

Flexible Spending Account (FSA) Please verify the FSA amount is accurate. For information on calculating eligible FSA expenses, click the "FSA Paid" link

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This is a reminder for clients who have an FSA indicator in your system. It warns users to ensure that they entered the amount correctly.

You have requested different Add values on the right and left eyes. Do you want to continue?

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In the Rx information, the right and left eyes have different +/- signs. That's rare, so we provide a warning.

The Plano option may not be covered by the patient's plan. Please refer to the Patient Record Report for details. Do you wish to continue

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This warning is displayed in any plano-only claim. Because plano lenses are not always covered, this warns users that they should ensure the patient is covered for plano-only. If the patient is not, the claim will be denied.

Unity Lens cannot be ordered with an Essilor AR coating

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Per the manufacturer's rules, a Unity lens with an Essilor coating cannot be made.

OFFEXP0076

Wholesale prices were provided by Maui Jim to ensure correct claim payment. Changing the amount may result in processing delays or incorrect payment

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This warning appears if the wholesale frame cost is manually changed on a Maui Jim frame.

OFFEXP0077

Selected Scratch Coating is not allowed with the selected Lens Material

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If scratch coating A is selected with a nonplastic lens material, this warning appears.

Frame service is not payable

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Frame services V2020 and V2025 are not payable when the frame material service code (MF) is not payable.

Patient supplied frame is not separately payable

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VSP does not pay doctors for patient-supplied frames.

Lens service is not payable

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Deny the lens line if the VSP material line is denied or missing.

Lens enhancements billed are included in the lens reimbursement for Lab ID 100

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Lens enhancements are handled privately when the lab ID is 100, which signifies an independent lab that is not part of the VSP Contract Lab Network.

Lens enhancement is not allowed with the other lens enhancements billed

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• Some enhancements exclude other enhancements. The excluded enhancements are denied.

• Some enhancements are mutually exclusive. If more than one is billed, they are all denied.

OFFHDR4001

Service is not payable when frame is supplied by the patient or blank

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Carriers do not pay for frames that patients supply or that do not have a frame supplier.

PRELIQ0037

For VSP Vision Savings Pass, lab 100 is not allowed

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A VSP Vision Savings Pass product cannot be sent to lab 100.

Lab ID 100 is used for independent labs, which are not part of the VSP Contract Lab Network. Doctors pay independent labs directly.

PRELIQ0038

For VSP Vision Savings Pass, patient and lab supplied frames are not covered

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Frames must be supplied by a doctor for a VSP Vision Savings Pass product.

This warning is the same as OFFHDR4003.

PRELIQ0039

Unable to complete validation due to an internal system error. Group population code is missing

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This is an internal VSP data error. The user cannot correct it.

If you systematically hide this warning from doctors, you run a high risk that the problem will continue.

If you receive this warning, contact VSP.

PRELIQ0067

A primary medical eyecare diagnosis code is required

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Primary Eye Care and Diabetic Eye Care Plus product packages must have a medical diagnosis as their primary service.

ADJCOB0001

Coordination of Benefits is not allowed

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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.

ADJCOB0002

Coordination of Benefits is not allowed between two benefits on the same members plan

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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.

ADJCOB0003

Medicaid is always the payer of last resort. Benefits cannot be coordinated with Medicaid as Primary plan

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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.

ADJCOB0004

COB is not allowed for secondary Product Package

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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.

ADJCOB0005

Primary claim must be under the Member Relationship. Coverage as Dependent is always secondary

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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).

ADJPRD0005

Patient relationship is not found for the benefit

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This patient relationship is not accepted for the specified client product.

ADJPRD0016

Member not covered in Product for date of service

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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.

ADJUDI0008

Service requires Service Verification from VSP

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To include the service on a claim being submitted to VSP, you must provide a service verification number.

ADJUDI0020

Service requires a payable exam on the claim

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If a claim for this service does not include a billable line item for an exam, the claim cannot be submitted for payment.

ADJUDI0031

Service exceeds the maximum units allowed

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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.

ADJUDI0033

Wholesale Frame Cost is required for frame material service

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When a frame is submitted for reimbursement, the wholesale frame cost must be provided.

ADJUDI0034

Frame case is not payable

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A frame case is not a billable item when the frame is supplied by the patient.

ADJUDI0038

Lens enhancement is not allowed with the Lens Vision Type

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A lens enhancement was not billed with the correct bifocal base lens.

ADJUDI0041

The diagnosis pointer is pointing to an incomplete or invalid diagnosis code

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The diagnosis code is incomplete or invalid, AND it is being used as a diagnosis for a specific service line.

ADJUDI0042

The first diagnosis code on the claim is not allowed as primary

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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

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The diagnosis code is incomplete or invalid, AND it is listed as the primary diagnosis code on the claim

ADJUDI0070

Service code is not allowed with other services billed

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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.

ADJUDI0077

Visually necessary service. Invoice required

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CA Medicaid and Low Vision: You must bill Low Vision with the KX modifier to indicate verification.

ADJUDI0079

Lens dispensing is not allowed with the lens material type

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ADJUDI0081

Lens Vision Type does not match the billed lens Dispensing Code

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Non-PIA and PIA-Denied Medicaid: The lens dispensing and lens material codes must be for the same vision typeand both must be payable.

"PIA" stands for Prison Industry Authority.

ADJUDI0083

Service lines billed exceeds the maximum allowed

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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

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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.

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

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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

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Most authorizations are valid for 30 days, though they can vary.

ELIGIB0008

Exam is not included on the Authorization

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The exam is not authorized on the authorization the doctor is using.

ELIGIB0011

Authorization not found

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If the authorization is deleted, this error occurs.

ELIGIB0013

Authorization has been used by another claim

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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

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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.

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.

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.

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

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The consumer ID must be the same for the patient on the first and second authorizations.

OFFEXP0002

Please indicate whether the patient has any health conditions or confirm 'None'

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If a claim includes an exam, the exam must specify whether the patient has any health conditions.

OFFEXP0003

Please indicate whether or not dilation has been performed

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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

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The same diagnosis code was entered more than once in Box 21 of a CMS 1500 form.

OFFEXP0005

You must accept assignment to submit the claim

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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

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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.

OFFEXP0007

You have entered Duplicate Diagnosis Pointers. Diagnosis Pointers may be entered only once

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One claim line has the same diagnosis pointer multiple times.

OFFEXP0009

Please enter a valid Diagnosis Pointer

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A diagnosis pointer that is not pointer A–L is entered on a service line.

OFFEXP0010

Please specify a contact lens brand

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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

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In a prescription, lenses must be plano or meet the VSP minimum criteria.

OFFEXP0017

This claim includes more than 15 Service Lines. If all information is accurate please split services between multiple claims for submission

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Because of system limitations, a claim cannot have more than 15 service line items.

OFFEXP0018

The Frame Supplier is required

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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

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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

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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

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Necessary contact lenses (NCL) is aservice (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

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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

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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

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The amount deducted from the patient's flexible spending account (FSA) cannot be greater than the total amount the patient paid.

OFFEXP0031

In-office lens finishing is not available for this order

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The office, the product, or both do not meet the requirements for in-office finishing (IOF) lenses.

OFFEXP0032

Client is not set up for Flexible Spending Account. Please remove FSA Paid Amount

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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

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The patient's name is missing from the claim or has invalid characters.

OFFEXP0037

Please enter a valid Middle Initial for the Patient

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The middle Initial must be a single letter on the claim.

OFFEXP0038

Please enter a valid Patient Date of Birth

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The date of birth (DOB) is missing from the claim.

OFFEXP0039

Please enter a valid Insured First and Last name.

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The insured's name is missing from the claim or has invalid characters.

OFFEXP0040

Please enter a valid Middle Initial for the member.

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The middle Initial must be a single letter on the claim.

OFFEXP0041

Please enter a valid Insured Date of Birth.

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The date of birth (DOB) is missing from the claim.

OFFEXP0042

Please enter a valid address

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The address is missing from the claim, is too long, or contains invalid characters.

OFFEXP0043

Please enter a valid Phone Number

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The phone number on the claim is invalid.

OFFEXP0044

Please enter a valid First and Last name of Referring Provider

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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.

OFFEXP0045

Please enter a valid NPI for Referring Provider

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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

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The middle initial must be a single letter only on the claim.

OFFEXP0047

Please enter a valid Other Insured First and Last Name

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If any "Other Insurance" information is entered on the claim, the subscriber's first and last name must be entered and valid.

OFFEXP0048

Please enter a valid Other Insured Policy or Group Number

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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.

OFFEXP0049

Please enter a valid Plan Name or Program Name

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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.

OFFEXP0050

Another health benefit plan must be marked “Yes” when secondary insurance information is present

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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

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Must be valid if provided on the claim.

OFFEXP0052

Invalid character entered in Box 19 Additional Claim Information

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Must be valid if provided on the claim.

OFFEXP0053

A valid state code is required when patients condition relates to Auto Accident

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If Box 10b (Related to Auto Accident) on the CMS 1500 formis Yes, a valid two-character state code must be included.

OFFEXP0054

Please select one option for patient Health Coverage

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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.

OFFEXP0055

Please enter a valid Insured Middle Initial

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The middle initial must be a single letter on the claim.

OFFEXP0056

Please enter a valid Medicaid Resubmission Code

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This is required if an Original Reference Number (Box 22 on the CMS 1500 form) is specified. It must be valid if provided.

OFFEXP0057

Please enter a Valid Original Ref. No

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This is required if a Resubmission Code (Box 22 on the CMS 1500 form) is specified. It must be valid if provided.

OFFEXP0058

Please enter a valid Policy or FECA Number

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Must be valid if provided on the claim.

OFFEXP0059

Please enter a valid Plan or Program Name

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Must be valid if provided on the claim.

OFFEXP0060

The Patient Unable to Work To Date cannot be less than the From Date

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If Box 16 on the CMS 1500 formis Yes, the required From date cannot be later than the To date.

OFFEXP0061

The Hospitalization To Date cannot be less than the From Date

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If Box 18 on the CMS 1500 formis Yes, the required From date cannot be later than the To date.

OFFEXP0062

Contact Lens Brand contains an invalid character

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Must be valid if provided.

OFFEXP0064

The selected lens cannot be ordered without an Optical Center Height or Segment Height value

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Some lenses have a technical add-on attribute that requires these measurements to be added.

OFFEXP0065

Unity Lens cannot be ordered with an Essilor AR coating

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This is the manufacturer's restriction.

OFFEXP0066

Slab Off is not available for this lens product

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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

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This error occurs when a lens is not part of the eClaim channel.

OFFEXP0068

The Anti-reflective coating you selected is already included in the lens you selected from the lens list

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When anti-reflection is an inherent part of a lens, it cannot be added separately.

OFFEXP0069

Ethos Lens cannot be ordered with an Essilor AR coating

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This is the manufacturer's restriction.

OFFEXP0070

Lab is invalid for claims where VSP is not the Primary payer

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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

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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

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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

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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

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VSP charity orders must have a generic or VSP-branded lens.

OFFEXP0075

A VSP or Generic AR coating must be selected for Charity claims

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VSP charity orders must have a generic or VSP-branded anti-reflective coating.

OFFEXP0078

Address cannot be more than 30 characters

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This is the system limitation for the length of the Address 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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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).

OFFHDR2017

Invalid lab selected for In-Office Finishing (Uncut)

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Uncut lenses are limited to VSPOne locations.

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.

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.

OFFHDR2020

Invalid Lab selected for the benefit

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Claims for an Elements product must go to lab 199 (Columbus).

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.

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.

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.

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

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.

OFFHDR3001

Frame is not authorized on the Authorization

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The frame is not authorized on the authorization the doctor is using.

OFFHDR3002

Lens is not authorized on the Authorization

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The lens is not authorized on the authorization the doctor is using.

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.

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.

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.

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.

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.

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.

<<Rolled up from PRELIQ0044>>

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.

OFFHDR4008

Different lens materials are not allowed on the same claim

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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.

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.

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.

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.

A problem was encountered processing your request. Please try again. If you are still experiencing a problem, check back at a later time.

An error occurred and the system can't identify the reason. It may be a temporary problem. If it persists, contact VSP.

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.

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.

This error can have several different causes. Contact Eyefinity Customer Care at 800.942.5353 to resolve.

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.

PRELIQ0002

Patient's first and/or last name is missing.

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Patient's full name is required.

PRELIQ0003

A valid patient date of birth is required

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Patient's date of birth is required and must be valid.

PRELIQ0004

Insured name is required

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Insured member's name is required.

PRELIQ0005

Patient relationship is required

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Specify how the patient is related to the insurance subscriber.

PRELIQ0006

The date of service is missing

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The date the service was performed is required and must be valid.

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.

PRELIQ0008

Service code is required

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At least one HCPCS/CPT code must be billed.

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.

PRELIQ0010

Payment Arrangement ID field is invalid

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The tax ID is not valid.

PRELIQ0011

Rendering provider signature is required

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The signature of the person who provided the service is required.

PRELIQ0012

Diagnosis code is required

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At least one diagnosis code must be provided.

PRELIQ0013

All diagnosis codes are invalid

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At least one diagnosis code must be valid.

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)

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.

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.

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.

PRELIQ0034

Unit count is invalid

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Units cannot be less than or equal to 0 on a service line item.

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.

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.

PRELIQ0048

Patient Sex is required

Patient gender is required

Patient's gender is required.

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 .

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.

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.

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.

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.

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.

PRELIQ0066

ID Number of Referring Physician - Invalid check digit

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Encompass validates that the National Provider Identifier (NPI) is a valid ID, not just any 10-digit number.

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).

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.