VSP Formulary Updates—April 2020

VSP reviews material offerings regularly to ensure alignment with industry standards and continued choice and value for members and doctors. In April 2020, VSP will make changes to some materials. These formulary updates may change your lens enhancement fees for all plans. In-network VSP providers can find information about the specific changes in the Product Index and the Lens Enhancement Charts located in the Provider Reference Manual on VSPOnline at www.eyefinity.com beginning April 1, 2020.

Action Required: The formulary updates will be added to your system automatically. However, your practice must activate and price the affected lenses and lens attributes in Eyefinity Practice Management Administration. See Setting Up Lens Attributes Using the Standard Setup for instructions.

The following sections highlight some of the important changes included in the update:

Rimless Drill Miscellaneous Extra

The patient's out-of-pocket cost for the miscellaneous extra called Drill Mount Fee is changing as part of the formulary update. The patient's cost for this extra is now $30.00 for a pair of lenses. Eyeglass lens items are priced per lens in Eyefinity Practice Management, so we recommend that you assign Drill Mount Fee a retail price of at least $15.00 in Administration to ensure correct calculations.

The system automatically adds the Drill Mount Fee to VSP eyeglass orders when the frame is a rimless, drilled rimless, grooved rimless, or 3-piece mount.

If a prior authorization was obtained for a patient before April 1, 2020, the "SW" code for the Drill Mount Fee miscellaneous extra will be displayed in the Patient Record Report as "Covered" even though it is "Covered with Additional Copay $30". If the prior authorization is used on an order, the new $30 patient pay amount will automatically be applied for the Drill Mount Fee miscellaneous extra even though the Patient Record Report lists the amount as $0.

Blended Bifocal Miscellaneous Extra for Digital Polycarbonate Aspheric Lenses

A new miscellaneous extra called Blended Bifocal is being added to your system as part of the formulary update. Your practice must activate and price this miscellaneous extra before placing VSP orders with blended bifocal digital polycarbonate aspheric lenses.

You will now need to manually add the Blended Bifocal miscellaneous extra to VSP eyeglass orders when ordering these lenses, to ensure correct pricing.

Other Formulary Changes

The formulary update includes the following additional changes:

  • The patient's out-of-pocket expense for photochromatic and transition lenses was changed.
  • A new Digital option code for multifocal polycarbonate lenses was added.

In-network VSP providers can check the Product Index and the Lens Enhancement Charts located in the Provider Reference Manual on eyefinity.com at www.eyefinity.com and adjust pricing in Administration, as necessary.

Transitions Signature Generation 8 Lenses

Before your practice can create orders for the new Transitions Signature Generation 8 lenses, you must activate and price them in Administration. You must also inactivate the old Transitions Signature Generation 7 lenses. See Setting Up Eyeglass Lenses for instructions.