Determining a Patient's Eligibility
Authorizing Coverage and Benefits
Before providing services, make sure your patient is eligible for benefits by retrieving an authorization. At that time, you’ll get information about your patient’s plan, coverage, and current benefit eligibility. You’ll also get a unique authorization number for your patient. Remember: an authorization number doesn’t guarantee payment. Review any comments or notations at the bottom of the Patient Record Report to confirm patient eligibility. Confirmation is required to show that the services and materials provided meet our plan requirements before issuing payment.
Obtaining an Authorization Number
There are two ways to get an authorization number:
1. eClaim: Log onto eyefinity.com, go to the eInsurance tab or select Get Authorizations & Check Eligibility.
Click Member Search. Enter any one of the following valid search combinations:
- Full Member ID only. (Member ID can be SSN or Client-Specific Employee ID)
- Member first name, member last name, and date of birth (DOB).
- Last 4 SSN, member last name, and member first name.
- Last 4 SSN, member last name, member first name, and date of birth (DOB).
- Last 4 SSN, member last name, and DOB.
Note:
Enter more information for best results. Try SSN or Member ID to locate all records.
Important!
Make sure you choose the correct member and patient prior to issuing an authorization. If you’re not sure which member to choose, call VSP at 800.615.1883 for assistance.
2. Customer Service: Call VSP at 800.615.1883. Select “1” to use our automated phone system. Or, you can talk with a Customer Service representative who’ll check the patient’s current eligibility, provide plan information, and issue an authorization number.
Important!
Authorizations are usually effective for 30 days from the issue date. You’ll receive an ‘Invalid Authorization’ error message in eClaim if you submit a claim for a date of service not within the effective dates. If this happens, obtain a new authorization valid for the date of service and resubmit.
When you contact us, please provide the following information:
- Member and patient’s name
- Last 4 digits of the member’s SSN or the full client-assigned ID number
- Relationship to insured, if needed
- Member and patient’s DOB
- Date of service
Understanding Your Patient’s Coverage
Refer to the Patient Record Report or the Lens Enhancements Charges Report for an explanation of your patient’s coverage.
Important!
Before ordering or providing services, tell your patients that they’re responsible for payment of non-covered services and materials.
Member Vision Card
VSP patients have the ability to access and/or print a Member Vision Card from vsp.com, and may provide a card when visiting your practice for services.
Note:
A Member Vision Card isn’t required for services.
While the card will provide basic benefit/plan information, please don’t rely on it solely for benefit coverage information. You must verify your patient’s eligibility and obtain an authorization on eyefinity.com. To view what information is available on the card, please refer to the Member Vision Card Quick Reference Guide.