If you use a non-network provider, you must file a claim for reimbursement. Ensuring members easy access to quality care with Superior Vision can help drive improvements in HEDIS/Stars scores. Llame al Centro del Servicio al Cliente al 1.800.507.3800, y alguien que habla su idioma lo ayudara. In addition, if you have a LASIK benefit as part of your vision benefit package and use an in-network eye care professional, you can receive an upfront allowance towards your LASIK procedure, as well as any applicable discounts. Live customer service is available Monday through Friday from 8 a.m. to 9 p.m. and on Saturday from 11 a.m. to 4:30 p.m. Eastern time. However, on December 15, 2016, HHSC is changing its Medicaid fee schedule for therapy services. As a result it may not always be 100% up-to-date. You can set your browser to notify you when you receive a cookie, giving you the chance to decide whether to accept it. These P&Ps are internal guidelines relating to Versant Healths role as an administrator for payors of vision benefit claims. VSP is not affiliated with Metropolitan Life Insurance Company or its affiliates. Superior Vision is a Versant Health company. All rights Reserved. 3. It does not cover treatment of a medical or ophthalmologic condition. Many of the documents on this site are in PDF format. Cookies are used for the following purposes: As part of our effort to provide Superior Service, we strive to make our products and services accessible to all users, including individuals with disabilities. Personal Attendant Services. For more information, please review the following article: Therapy Fee Schedule Reimbursement Rates. Contact your Medical Plan if you have questions concerning coverage for treatment of a medical or ophthalmologic condition. Chrome PC & Mac: Select the hamburger icon (for older PC version it is a wrench) at top of screen > Settings > Show Advanced Settings (for older PC versions Select Advanced Content) and scroll to Web Content. If deemed necessary and appropriate, your grievance may be forwarded to our CQI program. All pages have page titles and title tags written for easy comprehension of the page content. If Superior Vision concludes that the covered service should be provided or the claim for a covered service shall be paid, the health insurer (NGLIC) is bound by Superior Visions decision. Materials co-pay applies to lenses and/or frames, not contact lenses. We welcome your feedback and suggestions. P.O. Author: j1tencati Created Date: 4/30/2018 5 . The member shall mail a written appeal to Superior Vision within sixty (60) days after receipt of the adverse decision. 2.Forward to the director the request for review, the terms of the agreement in the members policy, evidence of coverage or a similar document and all medical records and supporting documentation used to render the decision pertaining to the members case, a summary description of the applicable issues including a statement of Superior Visions decision, the criteria used and clinical reasons for that decision, the relevant portions of Superior Visions review plan and the name and credentials of the licensed health care provider who reviewed the case. You must have a printer configured. Pursuant to the requirements of this, Superior Vision shall select the provider physician or other health care professional who shall review the appeal and render the decision. Customer service representatives are trained to respond to calls quickly, resolve problems promptly and exercise sensitivity. Superior Vision. Coverage includes routine eye exams and corrective eyewear, including frames, lenses, and contact lenses. We will follow our standard business practices guidelines when resolving your problem or concern. Most problems or concerns can be handled with a single phone call. Aperture (the CVO services provider) will assist with a provider's credentialing process for Superior HealthPlan. Box 967 Rancho Cordova, CA 95741 Fax: 916.852.2277. TopTenReviews wrote "there is such an extensive range of documents covering so many topics that it is unlikely you would need to look anywhere else". Superior Vision's SmartAlert Wellness Program fosters communication between you, your eye care provider, and your primary care physician or . Access to better vision begins with having the qualified eye care professionals in our network, which helps us to ensure our members can find cost-effective care, and a variety of styles. A practitioner will need to register as a first time user to get started. Superior Vision does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex. See the Future with Envolve Vision. Serious dysfunction of any of the members bodily organs or parts. Callers may experience longer-than-usual wait times. Contact Us. Each Virtual Private Servers resides in a protected sandbox with 24/7 monitoring. Envolve Vision provides expert eye care benefit services for Medicaid, Medicare, and Health Insurance Marketplace member products with more than 30 years of experience operating as a full-service, eye care speciality Health Management Organization (HMO). Credentialing documents are submitted to Aperture through CAQH or Availity. The user-friendly drag&drop graphical user interface allows you to add or relocate areas. This section provides information about commonly used modifiers for Vision Care providers. Information is not shared with organizations not an entity of Superior Vision Services, its Web delivery partner, software vendors, brokers or service eye care specialists. If you have not yet completed the new registration, please do so nowyou'll be done in the blink of an eye! Medical reimbursement and dependent child care: Southern Administrators and Benefit Consultants, Inc. Post Office Box 2449 Madison, MS 39130-2449 1-800-844-2555 FAX (601) 856-8088 Subscriber Information Please print clearly Subscriber Name Daytime Phone Evening Phone Mailing Address City State Name of Employer Zip Patient Information Patient Name Date of Birth Authorization Number Full Time Student Yes // No Verification may be required Claim Information Single Vision Lenses Bifocal Lenses Progressive Lenses Date of Service Exam Frame Is the provider an in-network provider Provider Name Contacts Contact Lens Fitting Exam Extra Ad-Ons Other Phone Number If you saw an in-network provider Are you applying for reimbursement after using an in-store sale or promotion you pay in full and then submit your receipt to Superior Vision for reimbursement at the out-of-network rates. Get access to thousands of forms. If you have a problem or concern regarding claims, you should first call the Superior Vision Plan Customer Service toll free number. Except as provided in section F. (below), Superior Vision has: At any time during the formal appeal process Superior Vision may request an external independent review process. As a reminder, the fee schedule changes do not apply to therapy providers contracted under Superiors Payer Fee schedule. Superior Vision. We apologize for the delay and appreciate your patience while we resolve the issues. Superior Vision is a product offering from Versant Health, a company forged from the experience of two leading vision care plans. Plug-ins: Adobe Flash Player, Adobe Acrobat Reader, Windows Media Player. Windows OS: To zoom in press CTRL + PLUS SIGN (+). Use this form for reimbursement for services received from an out-of-network provider, . Site - Document Library. SVS-PRO10-001 v005 02/2014. If you do not already have AdobeReader installed on your computer, Click Here to download. . Emergency Medical Condition means the sudden, and at the time, unexpected onset of a health condition that manifests itself by acute symptoms of sufficient severity (including severe pain) such that the absence of immediate medical attention could reasonably be expected to result in: Grievance means a written complaint submitted by or on behalf of Covered Person regarding: Insurer means the insurance carrier underwriting the Superior Vision Plan. Most browsers have built-in accessibility features that our website supports. We built it for you - with access to over 104,000 in network eye care professionals and 50 of the top 50 major retail optical chains, we have you covered. To send a claim by paper, please mail claim forms to: Superior HealthPlan, Attn: Claims, P.O. Customer Service: 800-507-3800 . When resolving a problem or concern, we will consider all aspects of the particular case, including the terms of your insurance certificate, the policy and procedures that support your insurance coverage, the providers input, and your understanding and expectations of your coverage. Firefox Mac: Select button labelled Firefox (orange) at top of screen > Preferences > Content> Color. To request a formal grievance review you have three options. We're moving to a new login format for our secure Provider portal. If you believe you have a vision problem or condition, contact a qualified vision care professional immediately. Ensures that a website is free of malware attacks. We collect this information for the following reason: Information gathered at this site is used for: Web traffic and error reporting, account identification and service listing, contact information for follow up communication and customer care, eye care professional search functionality. Download the necessary form(s), print it out and fill in the required information. Your eyes deserve the best care from LASIK specialists you can trust. Details of the attempt that was made to resolve the problem. Superior Vision automated phone service is available 24/7. With Superior Vision, you will always receive quality, affordable eye care from qualified eye care professionals. UT System Links. LASIK surgery has been FDA-approved since 1995, and is performed to correct nearsightedness, farsightedness, and astigmatism. Log on to www.myCigna.com. Apply your electronic signature to the PDF page. Upon request, your provider shall we will sent a copy of this grievance and appeals notice within five (5) business days after the date the appeal is initiated pursuant to an expedited medical review, expedited appeal, informal reconsideration and/or formal appeal. Please click on your state below to view. We will let you know that your request was received by sending you a confirmation in writing or by email (if address is provider) within 15 business days. If you answered No to question 2, please note Superior Vision Network Providers should only collect for Copayments and/or Non-covered items at the time of service. For Urgent medical conditions, members are instructed to contact their Medical Plan or Provider or local UCC. Superior Vision is a product offering from Versant Health, a company forged from the experience of two leading vision care plans. The Exclusive Collection. All information presented on the Superior Vision website is provided solely for general consumer understanding and education. The name and identification number of the member asking for the review; Names of health care providers or administrative staff involved; and. To protect your account data in the unlikely chance of a system compromise, the website does not maintain a live connection to the main benefits system. Call 1 (877) 201-3602 for a free LASIK consultation. Provides free language services to people whose primary language is not English, such as: Operating System: Any version of Microsoft Windows family of operating systems. This browser accessible interface can be used to manage your site. . If these technologies are not available, our page design helps ensure graceful degradation. A customer service representative will work with you to help you understand your coverage or resolve your problem or concern as quickly as possible. SUPERIOR VISION See yourself healthy. ERISA provides that if your claim for a welfare benefit is denied, in whole or in part, you have the right to know why this was done, to obtain copies of all documents relating to the decision without charge, and to contest any denial, all within certain time schedules. Scheduling an appointment and understanding your benefits is simple. Disclaimer: Versant Health, Inc.s and each of its subsidiaries (together, Versant Healths) policies and procedures (P&Ps) are confidential and proprietary, and are subject to change at any time. The IHCP reimburses opticians (specialty 190) and optometrists (specialty 180) only for services . If you have questions about your rights and responsibilities under ERISA you may contact the Benefits Security Administration, US Department of Labor, 200 Constitution Avenue NW, Washington DC 20210. Office Hours: 8:00 a.m. to 5:00 p.m. CST / 8:00 a.m. to 6:00 p.m. CST (STAR Health only) After office hours, Superior's STAR Kids nurse advice line staff is available to answer questions and intake requests for prior authorization by calling 1-844-590-4883. Please refer to the following Superior Payer Fee Schedules for therapy reimbursement amounts: If you have additional questions regarding these fee schedule changes, please contact Provider Services at 1-877-391-5921 or your Account Manager. For a complete list of modifiers, refer to the Modifiers: Approved List section in this manual. Superior Vision seeks to provide opportunities to qualified diverse suppliers, including minority-owned, woman-owned, historically underutilized business zone (HUBZone), service-disabled veteran-owned, veteran-owned, small businesses and other disadvantaged business enterprises in the communities in which we operate and serve. This policy is for when members have questions or concerns about the quality of vision care that they receive, or have an issue with a claim. Moreover, you get full coverage for lenses, including polycarbonate. Just a few minutes to complete the claim form. Denial upheld If we continue to agree that the covered services or claim for a covered service should have been denied, the complainant will receive a written notice of that decision. To protect you we use SSL 3.0, [RC4 with 128 bit encryption (High); RSA with 1024 bit exchange]. Superior Vision Reimbursement Form Online Get Superior Vision Reimbursement Form Online How It Works Open form follow the instructions Easily sign the form with your finger Send filled & signed form or save superior vision reimbursement rating 4.8 Satisfied 49 votes information once your coverage begins. You may email us the completed forms or bring them with you on your next visit. The carrier for the NDPERS Vision Plan is Superior Vision. To zoom out press CTRL + MINUS SIGN (-). The member or the members treating provider shall submit to Superior Vision with the written formal appeal, any material justification or documentation to support the members request for the service or claim for a service. After completing the claim form, you may attach your receipt (s) OR print and mail copies of your claim form and receipt (s) to: Vision Service Plan. 4. Reimbursement will be sent to the Plan subscriber (see Help Sheet for definition) at the address Ambetter from Superior HealthPlan has on record (To view your address of record, please log on to Ambetter.SuperiorHealthPlan.com or call Member Services at 1-877-687-1196 (TDD/TTY: 1-800-735-2989). View Top 10 List Tenemos intrpretes en espaol, chino, vietnamita, tagalo y coreano. If you are a group that wants to participate in the file exchange program you will need to fill out online request form and submit it to the IS Department at Superior Vision Services for review. 2022 Versant Health Holdco, Inc. (Versant Health). Neither Superior Vision nor the Insurer shall discontinue coverage for or otherwise penalize any covered person or provider for exercising his or her right to file a complaint or grievance. Superior Vision is a registered trademark of Versant Health Holdco, Inc. AbileneTexas Midwest Eyewww.txmidwesteye.com(325) 670-3937, AustinEye Physicians of Austinwww.eyephysiciansofaustin.com(512) 583-2020, Dallas / Ft. WorthUT Southwestern Medical Center Laser Center for Vision Carewww.utswlasik.com(888) 663-2020, GalvestonUTMB Health Eye Centerwww.utmbeyecenter.com(281) 687-7022, HoustonUT Houston Medical Center Robert Cizik Eye Clinicwww.cizikeye.org(713) 559-5200, LubbockTexas Tech Laser Vision Institute(806) 743-7777, TylerEyeCare Associates of East Texaswww.eyecaretyler.com(903) 595-0500. If the members compliant is an issue of medical necessity under the coverage document and not whether the service is covered, a provider, physician, or other health care professional who is licensed pursuant to title 32 of the Arizona revised statutes, chapter 7,8,11,13,14,16,17,19 19.1, or 29 or an out of state provider physician or other health care professional who is licensed pursuant to title 32 of the revised Arizona statutes, chapter 7,8,11,13,14,16,17,19 19.1, or 29 or an out of state provider, physician or other health care professional who is licensed in another state and who is not licensed in Arizona and who typically manages the medical condition under appeal shall review the appeal and render a decision based on the utilization review plan adopted by Superior Vision. Mail or fax a copy of the itemized invoice or receipt imprinted with the provider s name and address along with this form to the contact information below. We will maintain a record of each Grievance, including the response for each grievance review, for up to seven (7) years. Members should not delay in contacting a vision/eye care professional based on information they have obtained from this site, or any site whose link may be found on the Superior Vision website. You can call our Customer Service Department at (800) 638-3120. We strongly advise users to always seek the advice of a vision/eye care professional with any questions about vision and eye care or any medical condition. We also set the language and title attributes in the properties so assistive technologies know what language to use. Superior Vision, bajo el Programa de Asistencia Lingstica (LAP, por sus siglas en ingls), provee el servicio gratuito de interpretacin a nuestros miembros que prefieren contactarnos en espaol. When timed response is required, the user is alerted and given sufficient time to indicate more time is required. Forms 10/10, Features Set 10/10, Ease of Use 10/10, Customer Service 10/10. Superior has updated our claims system to reimburse the updated fee schedule rates: Please review the Texas Medicaid and Health Partnership (TMHP) Online Fee Schedule for updated fee schedule reimbursement rates. Box 30978 Salt Lake City, UT 84130 Fax: (248) 733-6060 Questions? It has full administrative capabilities and will allow you to set preferences. Please contact us if you have any issues accessing information on this website. You can also request any materials on this website in another format, such as large print, braille, CD or in another language. Notwithstanding title 41 of the Arizona revised statutes, chapter 6, article 10 and section 12-908, if a party to a decision issued under this section seeks further administrative review, the department shall not be a party to the action unless the department files a motion to intervene in the action. To change foreground and background colors: We are trying to make our website as accessible as possible for all of our visitors. We provide the following to ensure individuals with disabilities have access to our services. To enable us to maintain our strong quality assurance and improvement standards, Superior Vision has a formal grievance policy and procedure. If you encounter a PDF that you cannot read, please contact us. Author: Also, you'll have the option to add on important features like anti-glare, UV protection, transition lenses, and premium progressives. Structural markup to indicate headings and lists (semantics) to aid in page comprehension. Superior Vision generally mails reimbursements within 10 business days of receipt to the address you have on file with ERS. We are currently experiencing technical issues impacting our service operations, including our member and provider portals. However, with our preconfigured online templates, things get simpler. The availability, delivery, or quality of vision care services; Claims payment, handling, or reimbursement for vision care services; or. Urgent means non-life or limb threatening, or vision acuity is affected prior Vision Plan provides wellness benefits for routine eye examinations and eyewear in accordance with the terms and conditions of the Master Policy. Except as provided in section K. (below) within sixty (60) days after the member receives written notice by Superior Vision of the adverse decision, if the member decides to initiate an external independent review, the member shall mail to Superior Vision a written request for an external independent review, including any material justification or documentation to support the members request for the covered service or claim for a covered service. Pages are designed to avoid causing the screen to flicker with a frequency greater than 2 Hz and lower than 55 Hz. Except as provided in section K of this section, for cases involving an issue of coverage, within fifteen (15) business days after receipt of all of the information prescribed in section C (above) from Superior Vision, the director shall determine if the service or claim is or is not covered and if the adverse decision conforms to Superior Visions utilization review plan and this article and shall mail a notice of determination to Superior Vision, the health insurer, the member and the members treating provider. Follow the simple instructions below: The preparing of legal documents can be costly and time-ingesting. The Superior Vision insurance customer service phone number is 1-800-507-3800. 5. If you disagree with the decision or explanation given to you by the customer service representative or if you have a complaint about any other issue regarding your insurance you may request a grievance review. If the director finds that the case involves a medical issue or is unable to determine issues of coverage, the director shall submit the members case to the external independent review organization in accordance with section E (above) or K (below). Their eye care solutions are comprehensive, and on average, provide savings of 20% or more on eye-related costs. Superior Vision is a Versant Health company. Call 1 (877) 201-3602 for a free LASIK consultation. . Thank you in advance for helping us with our continued improvement to serve you better. In the case that you are not pleased with the quality of care or level of service obtained through one of our participating eye care professionals, we encourage and request that you notify us in writing as soon as possible. Title: Member Reimbursement Claim Form Author: Superior Vision Subject: Expense Reimbursement Created Date: Check the dialog boxes to set individual preferences. You will need Adobe Reader to open PDFs on this site. Effective for dates of service on or after September 1, 2019, the Medicaid-implemented fee schedule changes for Medicaid services are listed below. Reimbursement Rate Changes. Check your benefits schedule to see how vision is covered Your Employer If you have co-pays these are paid to your in-network provider at the time of your visit. . (20-2535 Expedited medical review; expedited appeal) not applicable. Please call our Customer Service department at (800) 507-3800 12-2019. Everything needed to begin using the account will be contained in this document, except for your password. This site, its services and content do not constitute the practice of any vision care, medical, or other professional health care advice, diagnosis or treatment. Superior Vision Services is concerned about your security. If you are looking for an eye doctor or need assistance in choosing one nearest you, you may call the customer service toll-free telephone number shown on your ID card, or visit the Superior Vision Services website: superiorvision.com. The Superior Vision Plan is a vision care program designed to offer a high-level of vision care to you and your family. Who We Serve We are proud to serve over 38.5 million client members through our third-party government and health plan relationships. Box 967 Get your online template and fill it in using progressive features. Web pages are designed so that all information conveyed with color is also available without color. We will use every opportunity to be reasonable in find a solution that makes sense for all parties. You can enter a new search by hitting the New Search image. Superior Vision Services, Inc. administers this plan to provide access to our network of vision care providers. But for anti-scratch coating, you only get discounts. We strongly advise members to always seek the advice of a vision/eye care professional with any questions about vision and eye care or any medical condition. STAR Health (Foster Care) 1-877-391-5921. Written resolution of the grievance review will include the specific information considered and an explanation of the basis for the decision. spherocylinder single vision plano to +/- 4.00d sphere 2.12 to 4.00d cylinder per lens 0 999: 01/01/1994 12/31/9999: 2 17.93: v2105 fee on file: spherocylinder single vision plano to +/- 4.00d sphere 4.25 to 6.00d cylinder per lens 0 999: 01/01/1994 12/31/9999: 2 19.80: v2106 fee on file: spherocylinder single vision plano to +/- 4.00d sphere . It is best viewed with Java Script enabled. We invite you to experience the highest quality of care while taking advantage of the discounts offered to Superior Vision Services members. Superior Vision contracts with various LASIK networks. . Superior Vision Services Attn: Claims Processing P.O. They have performed thousands of successful LASIK procedures for Texans across the state, and they offer cutting-edge technology and techniques. To zoom out press COMMAND + MINUS SIGN (). Once your request is received, we will research the case in detail, ask for more information as needed and let you know, in writing, of the decision or the outcome of the investigation into your case. This data will be given to ourselves and our agents. Email: Customer Service. In the dialog box, select Content > Fonts & Colors. This includes uploading and downloading files. These exams promote early detection and treatment of chronic conditions. Superior Vision - Coronavirus update to eye care professionals. Within five (5) business days after receiving a notice of decision from the independent review organization, the director shall mail a notice of the decision to Superior Vision, the health insurer, the member and the members treating provider. These P&Ps are not intended to dictate medical care decisions, and they do not and should not be interpreted as a substitute or replacement for a treating physicians prudent clinical judgment at the time vision services are delivered to a patient. Products and Services From routine vision care to medical management, we offer distinct capabilities and flexible solutions. Highest customer reviews on one of the most highly-trusted product review platforms. Effective for dates of service on or after September 1, 2019, the Medicaid-implemented fee schedule changes for Medicaid services are listed below. Superior Vision Attn: Claims Processing P.O. I completed the reimbursement form and mailed it along with a copy of the Contacts Direct receipt to Superior Vision on 4/1. Superior Vision has adopted the following Priority 1 Checkpoints of the Web Content Accessibility Guidelines 1.0 (WCAG 1.0) (May 5 1999) published by the Web Accessibility Initiative of the World Wide Web Consortium: 1.1, 1.4, 2.1, 6.1, 1.2, 9.1, 5.1, 5.2, 12.1, 7.1, 11.4 as our website accessibility standard and are working to ensure that our website complies with that standard, as well as Section 508 of the U.S. 10 business days of receipt to the address you have any issues accessing information this. Will work with you to help you understand your coverage or resolve your problem concern! Discounts offered to Superior Vision, you must file a claim for reimbursement including polycarbonate Plan if use., the fee schedule for therapy services days of receipt to the address you have a problem or concern quickly! Or concerns can be used to manage your site was made to resolve the.. 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