The Integrated Primary EyeCare Program lets VSP network doctors work directly with VSP’s health plan clients to obtain eligibility, authorizations, and submit claims for medical eyecare. The program is an addition to the VSP medical product portfolio that supports the ability of all VSP network doctors to practice to their full scope of licensure.

Through Integrated Primary EyeCare, enrollees of VSP-contracted health plan clients will gain access to VSP network doctors. At the time a health plan client contracts with VSP to provide this program in your area, you will be provided with specific health plan client information, including the negotiated reimbursement rate.

Enrollment will be automatic for each network in which a doctor participates (e.g., VSP, Select, Advantage, Choice, and Medicaid). Integrated Primary EyeCare patients can only be referred to another doctor or refused service, if you’re not licensed to perform the service needed.

To render services through this program, VSP network doctors agree to:

• Maintain an active status with VSP.
• Follow each health plan client’s policies and procedures relating to the delivery of medical eyecare.
• Be listed in the health plan’s provider directory.
• Accept compensation that is based on a percentage of the Medicare or Medicaid fee schedule for your locality and/or state, and which may vary by client. (See Client Details pages of the VSP Provider Reference Manual for specific details.)
• See all eligible members of VSP-contracted health plan clients.
• Submit Integrated Primary EyeCare claims to the patient’s health plan carrier, not to VSP.
• Accept payment for services under the program from the patient’s health plan carrier or its administrative services provider, not VSP.
• Accept payment, less any copays or coinsurance by the VSP-contracted health plan client, as payment in full for services covered under the Integrated Primary EyeCare Program.
• Submit all complaints and grievances regarding Integrated Primary EyeCare patients and claims to the health plan client, and hold VSP harmless from such complaints and grievances.

Please refer to Client Details for additional information.

Compensation is based on a percentage of either the Medicare RBRVS allowables for your location or the state Medicaid fee schedule. VSP will negotiate the reimbursement rate with the health plan client on the doctors’ behalf. Each client contract requires clients to follow state and federal guidelines when paying doctors.