BCBSM-MESSA (Blue Cross Blue Shield of Michigan - MESSA)
Providers will be able to locate MESSA members in the VSP system using their full SSN or by searching by name, date of birth, and the last four digits of their SSN. Should MESSA members present their Blue Cross/MESSA insurance card, staff should use it as identification only. MESSA members’ Enrollee ID’s are not going to be used as an identifier in the system.
Coordination of Benefits (COB)
Follow VSP’s standard COB process. When paying secondary, please use the below COB secondary allowances.
Maximum COB Secondary Allowances
|
VSP-1 |
VSP-2 |
VSP-3 |
VSP-3 Plus |
VSP-1 B |
VSP-2 S |
VSP-3 G |
VSP-3 Plus P |
|
|---|---|---|---|---|---|---|---|---|
|
Exam |
$38 |
$38 |
$38 |
$38 |
$38 |
$38 |
$38 |
$38 |
|
Lenses |
$50 |
$50 |
$50 |
$70 |
$50 |
$50 |
$50 |
$70 |
|
Frame |
$50 |
$65 |
$65 |
$80 |
$130 |
$130 |
$130 |
$130 |
|
Deductible |
$35 |
$24.50 |
None |
None |
$35 |
$24.50 |
None |
None |
Plan Details
Important!
Effective January 1, 2021 MESSA has added 3 new Choice Plan offerings* “MESSA Vision, MESSA Vision Enhanced, and MESSA Vision Preferred” and has retired their Signature Plan “VSP-1”. All other plans will stay the same.
*Please refer to the Choice PRM for plan benefit information.
|
Plan Name |
Exam Copay |
Materials Copay |
Elective Contact Lens Allowance |
Frame Allowance |
Covered Lens Enhancements |
Other Lens Enhancements |
|---|---|---|---|---|---|---|
|
VSP-1 |
$10 |
$25 |
$65 total; see Note #1 |
$65 retail/ $26 whlsl. |
Rimless drilling and grooving, Pink 1 or 2 tints. |
Tints other than Pink 1 or 2, photochromics, oversize blanks, blended/progressive lenses, and all items on the VSP Signature Plan Lens Enhancements Chart. |
|
VSP-2 |
$6.50 |
$18 |
$90 total; see Note #1 |
$65 retail/ $26 whlsl. |
For both: |
For all: |
|
VSP-3 |
None |
None |
$115 total; see Note #1 |
$65 retail/ $26 whlsl. |
||
|
VSP-3 Plus |
None |
None |
Non-Disposables: Covered in full. Disposables: The allowance is $200 Total. Deduct 20% from the balance of the U&C fees for routine exam, contact lens services and first three months materials after applying the patient’s allowance. See Note #4. |
$80 retail/ $35 whlsl. |
Rimless drilling and mounting, all tints, photochromics, oversize blanks, blended and progressive lenses including smart-segs, polarized lenses. |
|
|
VSP-A |
$10 |
None |
$65 |
N/A; see Note #2. |
N/A; see Note #2. |
N/A; see Note #2. |
|
VSP-1 B |
$10 |
$25 |
$85 total; |
$130 retail/$50 whlsl. |
Rimless drilling and mounting, Pink 1 or 2 tints. |
Tints other than Pink 1 or 2, photochromics, oversize blanks, blended/progressive, and polarized lenses. |
|
VSP-2 S |
$6.50 |
$18 |
$110 total; |
$130 retail/$50 whlsl. |
For both: |
For all: |
|
VSP-3 G |
None |
None |
$135 total; |
$130 retail |
||
|
VSP-3 Plus P |
None |
None |
Non-Disposables Covered in full. Disposables limited to a Total: contact lens plan with $250 allowance, including routine exam, contact lens services, and materials; see Note #3 and Note #4 |
$130 retail/ $50 whlsl. |
Rimless drilling and mounting, all tints, photochromics, oversize blanks, blended and progressive lenses (including smart-segs), polarized lenses. |
|
Plan Name |
Exam Copay |
Materials Copay |
Elective Contact Lens Allowance |
Frame Allowance |
Covered Lens Enhancements |
Other Lens Enhancements |
|---|---|---|---|---|---|---|
|
VSP-1 |
$10 |
$25 |
$65 total; see Note #1 |
$65 retail/ $26 whlsl. |
Rimless drilling and grooving, Pink 1 or 2 tints. |
Tints other than Pink 1 or 2, photochromics, oversize blanks, blended/progressive lenses, and all items on the VSP Signature Plan Lens Enhancements Chart. |
|
VSP-2 |
$6.50 |
$18 |
$90 total; see Note #1 |
$65 retail/ $26 whlsl. |
For both: |
For all: |
|
VSP-3 |
None |
None |
$115 total; see Note #1 |
$65 retail/ $26 whlsl. |
||
|
VSP-3 Plus |
None |
None |
Non-Disposables: Covered in full. Disposables: The allowance is $200 Total. Deduct 20% from the balance of the U&C fees for routine exam, contact lens services and first three months materials after applying the patient’s allowance. See Note #4. |
$80 retail/ $35 whlsl. |
Rimless drilling and mounting, all tints, photochromics, oversize blanks, blended and progressive lenses including smart-segs, polarized lenses. |
|
|
VSP-A |
$10 |
None |
$65 |
N/A; see Note #2. |
N/A; see Note #2. |
N/A; see Note #2. |
|
VSP-1 B |
$10 |
$25 |
$85 total; |
$130 retail/$50 whlsl. |
Rimless drilling and mounting, Pink 1 or 2 tints. |
Tints other than Pink 1 or 2, photochromics, oversize blanks, blended/progressive, and polarized lenses. |
|
VSP-2 S |
$6.50 |
$18 |
$110 total; |
$130 retail/$50 whlsl. |
For both: |
For all: |
|
VSP-3 G |
None |
None |
$135 total; |
$130 retail |
||
|
VSP-3 Plus P |
None |
None |
Non-Disposables Covered in full. Disposables limited to a Total: contact lens plan with $250 allowance, including routine exam, contact lens services, and materials; see Note #3 & Note #4. |
$130 retail/ $50 whlsl. |
Rimless drilling and mounting, all tints, photochromics, oversize blanks, blended and progressive lenses (including smart-segs), polarized lenses. |
Important!
Exam and material copays don’t apply to contact lenses. Don’t collect these from your patient or deduct them from your patient’s contact lens allowance
Client Detail Notes
Note #1: Add your U&C fees for professional services & materials, then apply your patient’s allowance. Deduct 20% from any remaining balance. For disposable contacts, only deduct 20% from the first three months’ supply. This replaces the standard contact lens benefit of 85% of U&C for exam, fitting, and evaluation.
Note #2: Patients are responsible for lenses and frames, so please give them itemized receipts. They’ll submit charges to us for reimbursement. For contact lenses, charge your U&C fee, minus the allowance.
Note #3: Standard contact lens benefit of 85% of U&C for exam, fitting, and evaluation.
Note #4: As defined by MESSA: Disposables are daily and 1-2 week disposables. Non-disposables are conventional and planned replacement (including monthly and quarterly). When billing for 1-24 units of Planned Replacement lenses, enter “Planned Replacement” in Box 19.
Please use HCPCs-specific codes when filing VSP claims through eClaim. The Contact Lens Type drop-down list has HCPCS-specific codes and descriptions consistent with industry standards.
Covered Contact Lens Type Codes
|
HCPCS Description |
Covered* |
|---|---|
|
V2500—Hard/PMMA, spherical |
2 or less |
|
V2501—Hard/PMMA, toric or prism ballast |
2 or less |
|
V2502—Hard/PMMA, bifocal |
2 or less |
|
V2503—Hard/PMMA, color vision deficiency |
2 or less |
|
V2510—Gas permeable, spherical |
2 or less |
|
V2511—Gas permeable, toric, prism ballast |
2 or less |
|
V2512—Gas permeable, bifocal |
2 or less |
|
V2513—Gas permeable, extended wear |
2 or less |
|
V2520—Soft/hydrophilic, spherical |
24 or less, see Note #4 |
|
V2521—Soft/hydrophilic, toric or prism ballast |
24 or less, see Note #4 |
|
V2522—Soft/hydrophilic, bifocal |
24 or less, see Note #4 |
|
V2523—Soft/hydrophilic, extended wear |
24 or less, see Note #4 |
|
V2530—Scleral, gas impermeable per lens |
2 or less |
|
V2531—Scleral, gas permeable |
2 or less |
|
V2599—Other |
2 or less |
*Number of units covered, up to the maximum. Don’t balance-bill patients. An allowance applies if units are over this amount.
Elective Contact Lens Allowance
Patients can use the Elective Contact Lens allowance only to pay for new or replacement contact lenses. The allowance doesn’t cover lost or damaged lenses, except at covered intervals.
Other Lens Enhancements
If your patient chooses a lens enhancement that is covered with copay, charge your U&C fee for the Starter Plan or the patient copay for all other plans.
If you offer a special promotion or discount, charge whichever is lower: Your “special” fee or 80% of U&C. If you’re charging the patient your “special” fee, explain that in “Special Instructions.”
Note:
Using the Elective Contact Lens allowance makes the patient ineligible for any other service or materials for that eligibility period.
The following items aren’t covered and are a private transaction between you and your patient:
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