Children’s Vision Exams, Including Refraction – Effective July 1, 2024

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Bulletin

October 1, 2024, 10:01AM

To:

All Providers and Managed Care Organizations (MCOs) Participating in the Virginia Medical Assistance Program

From:

Cheryl J. Roberts, Director Department of Medical Assistance Services (DMAS)

The purpose of this bulletin is to notify MCO and fee-for-service providers that effective July 1, 2024, vision service providers, including children’s mobile vision clinics, should use HCPCs S0620 to bill for children’s routine ophthalmological examination including refraction; new patient. Providers are also eligible to void previously paid claims and rebill claims using HCPCS S0620 as appropriate, i.e., for children’s vision exams meeting the service description above, for dates of service on and after July 1, 2024, including for fee-for-service and managed care enrolled members. Please refer to the Department of Medical Assistance Services’ (DMAS’) Practitioner Manual, Chapters IV and V for information regarding vision coverage and billing instructions. Rates for vision CPT and HCPCS codes are posted on the DMAS website at https://www.dmas.virginia.gov/for-providers/rates-and-rate-setting/.

Providers may contact the MCO Vision Subcontractors directly for additional guidance as needed on MCO vision services claims payment.

MCO Vision Subcontractor

Contact Information

EyeMed - Anthem

(800) 901-0020

https://www.eyemed.com/en-us/provider

March Vision - UnitedHealthcare

(855) 476-2724

www.marchvisioncare.com

VSP Vision - Aetna

(800) 615-1883

https://www.vspproviderhub.com/

VSP Vision – Molina

(800) 877-7195

https://www.vspproviderhub.com/

VSP Vision - Sentara

(800) 877-7195

https://www.vspproviderhub.com/

To avoid disruption to claims payment through FFS and the MCOs providers must periodically check the DMAS provider portal, also known as the Provider Services Solution (PRSS), to ensure that the provider's enrollment, contact information, and license information is up to date, for all of the provider's respective service locations. Under federal rules, MCOs and DMAS are prohibited from paying claims to network providers who are not enrolled in PRSS. Additional information is provided on the MCO Provider Network Resources webpage and includes links to resources, tutorials and contact information to reach Gainwell with any provider enrollment or revalidation related questions. Dental providers should continue to enroll directly through the DMAS Dental Benefits Administrator, DentaQuest.

PROVIDER CONTACT INFORMATION & RESOURCES

Virginia Medicaid Web Portal Automated Response System (ARS)

Member eligibility, claims status, payment status, service limits, service authorization status, and remittance advice.

https://vamedicaid.dmas.virginia.gov/

Medicall (Audio Response System)

Member eligibility, claims status, payment status, service limits, service authorization status, and remittance advice.

1-800-884-9730 or 1-800-772-9996

Provider Appeals

DMAS launched an appeals portal in 2021. You can use this portal to file appeals and track the status of your appeals. Visit the website listed for appeal resources and to register for the portal.

https://www.dmas.virginia.gov/appeals/

Managed Care Programs

Cardinal Care Managed Care and Program of All-Inclusive Care for the Elderly (PACE). In order to be reimbursed for services provided to a managed care enrolled individual, providers must follow their respective contract with the managed care plan/PACE provider. The managed care plan may utilize different guidelines than those described for Medicaid fee-for-service individuals.

Cardinal Care Managed Care

https://www.dmas.virginia.gov/for-providers/managed-care/cardinal-care-…

PACE

Program of All-inclusive Care (virginia.gov)

Acentra Health

Behavioral Health Services

https://vamedicaid.dmas.virginia.gov/sa

Provider Enrollment

In-State: 804-270-5105

Out of State Toll Free: 888-829-5373

Email: VAMedicaidProviderEnrollment@gainwelltechnologies.com

Provider HELPLINE