Getting Member Eligibility and VSP Authorization

This section calls attention only to the fields and options required for the VSP Interface. For complete information about setting up patient insurance information, go to Recording Patient Information.

1. Open the Patient Demographic window. For more information, go to Creating and Opening Patient Records.
2. Ensure that you have recorded the patient’s name, address, home phone number, sex, date of birth, social security number, marital status, and employment status in the Demographic tab.
3. Click the Insurance tab in the Patient Demographic window.
4. Click New Ins.
5. Select Vision Service Plan or VSP from the Insurance Name drop-down menu.
6. Type the last four digits of primary member’s social security number or unique ID in the Insured ID (Box 1a)text box or select the Patient SSN check box.

   Alternatively, you can enter the complete social security number or VSP unique ID number.

7. Select Vision Service Plan or VSP from the Plan Name (Box 11c) drop-down menu.
8. Select the patient’s relationship to the insured party from the Relationship to Insured (Box 6) drop-down menu.

1. Open the VSP member’s Patient Demographic window.
2. Click the Insurance tab.
3. Select Vision Service Plan or VSP from the list of patient insurances.
4. If you already have an authorization, click Enter Existing Authorization to manually enter and validate an authorization number.
5. Click Eligibility/Authorization.
   • You must click Eligibility/Authorization even if you entered an existing authorization.
   • A check mark next to the Eligibility/Authorization button indicates that the patient has an active VSP authorization that is less than thirty days old.

   The VSP Eligibility/Authorization window opens.

6. Click Get Authorization to retrieve eligibility information, a new authorization, or a back-dated authorization.

   The Response from VSP window opens and displays the VSP members(s) and groups(s) that match the information recorded for your patient.

7. If more than one patient or group are displayed, select your patient and the patient’s current group and click Get Eligibility.

   Your Web browser opens to display the patient’s eligibility.

8. If a security message appears at the top of the window, click it, select Allow Blocked Content, and click Yes on the Security Warning window to run the active content.

   The Patient Eligibility for Providers Web page opens and displays the plan summary for the patient.

9. Click the × in the top right corner of the window to close the Patient Eligibility for Providers window after viewing or printing the information.
   You can view and print the eligibility information at any time from the VSP Eligibility/Authorization window. Double-click the authorization that you want to view.
10. Select a benefit from the Benefit drop-down menu.

    A list of services is displayed in the Service box.

11. If you only want to obtain authorization for a specific service or group of services (split authorization), select them from the Service box.
12. If this is a back-dated authorization, type the date of the service in the Back-Date Auth? field.
13. Click Authorize to obtain authorization for all of the services listed for the benefit you selected.

    When CL Exam is selected, Lens is also automatically selected because VSP expects a lens to accompany a contact lens exam.

    The VSP-IDC Patient Record Web page opens.

14. Click the × in the top right corner of the window to close the VSP-IDC Patient Record window after viewing or printing the information.
15. If you are coordinating benefits between primary and secondary VSP insurances, repeat steps 3–14 for the secondary plan.

    You can view and print authorizations at any time. For more information, go to To view authorizations .

You can quickly view eligibility, doctor reports, and packing slips that you have received from Eyefinity on the Patient Demographic window.

1. Open the VSP member’s Patient Demographic window.
2. Click the Insurance tab.
3. Select Vision Service Plan or VSP from the list of patient insurances.
4. Click Eligibility/Authorization.

   The VSP Eligibility/Authorization window opens.

5. Select an authorization from those listed at the top of the window.
6. Click View Eligibility, as needed, to view the patient’s eligibility that was transmitted from VSP.

   Eligibility information is not available until an authorization has been received from VSP. For information, go to To obtain VSP member eligibility and authorization information.

   Your Web browser opens to display the eligibility information.

7. If you need to delete an authorization so a new one can be obtained, select the authorization from the list and click Delete.

   Deleting an authorization removes it from OfficeMate and from VSP.

8. Click Dr. Service Report and Packing Slip to view reports that are associated with the selected authorization.

   The doctor service report and packing slip are not available until the claim has been submitted. For information about submitting VSP claims, go to Recording VSP Fee Slips

9. Click Exit to close the VSP Eligibility/Authorization window.

1. Open the VSP member’s Patient Demographic window.
2. Click the Insurance tab.
3. Select Vision Service Plan or VSP from the list of patient insurances.
4. Click Eligibility/Authorization.

   A check mark next to the Eligibility/Authorization button indicates that the patient has an active VSP authorization that is less than thirty days old.

   The VSP Eligibility/Authorization window opens.

5. Double-click an authorization or select an authorization from those listed at the top of the window and click View.
6. To print a list of the patient’s VSP authorizations, click Print List.
7. Click Exit to close the VSP Eligibility/Authorization window.