Insurance Estimator 1. Overview 1. Setup - Admin 2. Administration 2. Inventory 7. VSP Product Pricing 8

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1 Insurance Estimator Insurance Estimator 1 Overview 1 Setup - Admin 2 Administration 2 Inventory 7 VSP Product Pricing 8 Copy Inventory > For Multi-Location Practices 10 Orders 11 Page 1

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3 Insurance Estimator Overview The Insurance Estimator allows you to spend more time with your patients instead of calculating charges and patient portions for VSP orders. This tool makes it easy to calculate the chargeback, recoup, patient co-pay and overages on both eyeglass and contact lens orders. We have created this guide to assist you in setting up and using the Estimator. If you have any questions, please do not hesitate to contact Customer Support. Page 1

4 Setup - Admin Administration General Access Admin > General > Practice Preferences > Additional Preferences > RevAssistant Automation. Enable 'Yes' for "Enable Eyefinity Automation" and "Enable Eyefinity Billing Estimator." Example Access Admin > General > Locations > (open your location) > Click 'Edit' > Order Processing slider > highlight Eyefinity/RevAssistant > click the checkbox beside "Enabled." Repeat for all locations that will use this feature. Example Page 2

5 Logout and log back in. Data Configuration Your practice may have "Balance Transfer Reasons" and "Balance Writeoff Reasons" configured that are similar to the recommendations we have provided in the instructions. If so, it is not necessary to have additional reasons added and you can skip to the Accounting setup instructions. Access Admin > Data Configuration > Accounting > Balance Transfer Reasons. 1. Click 'Add Item.' The right side of the screen will be available for text entry. 2. In the "Name" field, input "Coinsurance/Copay." 3. Click 'Add.' 4. Repeat steps 1-3 and add "Exceeds VSP Benefits." Access Admin > Data Configuration > Accounting > Balance Writeoff Reasons. 1. Click 'Add Item." The right side of the screen will be available for text entry. 2. In the "Name" field, input "VSP." 3. Click 'Add.' 4. Repeat steps 1-3 and add "VSP Recoup." Accounting To complete the Accounting setup, you will need a copy of the most recent VSP fee schedules and VSP Doctor Assigned Fee Report. Fee schedules - Login to Eyefinity. o o Signature: VSP Online > Manuals > VSP > Tools & Forms > VSP Signature Plan Lens Enhancement Chart and Manuals. Choice: VSP Online > Manuals > Choice > Tools & Forms > VSP Choice Plan Lens Enhancement Chart. VSP Doctor Assigned Fee Report - Login to Eyefinity > VSP Online > Quick Links & Tools > Update Practice Information > View or Update Fees > View Current Fees > click 'Go' > select the appropriate Fee Code > click 'View Filed Fees.' Page 3

6 Fee Schedule - Signature 1. Access Admin > Accounting > VSP Fee Schedules. 2. Verify the correct location is displayed within the "Location" dropdown menu. Example 3. Click 'New Fee Schedule.' 4. "Signature" and "Custom" are the two Fee Schedule Template options. Highlight "Signature" and click 'Continue.' VSP's Signature Fee Schedule will load. (Note: Instructions for Custom fee schedules are included on this page after Choice instructions.) 5. If you prefer, change the fee schedule name. Check the box beside "Active" and indicate the begin and end date. Within the dropdown menus, select the appropriate Write-Off, Recoupment, Patient Transfer, and Patient Copay. Example 6. Input the appropriate "Frame Service Fee" that is obtained from the VSP Doctor Assigned Fee Report. 7. Input the appropriate CL Fitting % Covered amount. 8. Refer to VSP Signature Fee Schedule obtained from Eyefinity's website: a. Pricing has been pre-loaded, however, we recommend the price is verified for accuracy. b. Click within the pricing field to enter Exam Services Reimbursement amounts. Reminder: Eye Exam fees DO NOT include refraction. Refraction fees need to be added separately. Example c. Access the Base Lenses slider and click within the Retail Cost and Service Fee fields to update pricing PER LENS. Page 4

7 d. Access the Lens Addons slider. Click within the pricing field to update pricing PER LENS. e. If necessary, add items to the price list with the 'Add' button at the bottom of every pricing screen. f. The 'Delete' button will completely delete the line of information. g. Click 'Create' when all pricing information is complete. Fee Schedule - Choice 1. Refer to VSP Choice Fee Schedule obtained from Eyefinity's website: a. Follow steps 3, 4, 5, and 6 listed above. b. Change the fee schedule name to "Choice" or another name that your office will reference. This will ensure the complete list of Exam Services, Base Lenses, and Lens Addons will load. c. Update all the information to reflect the Choice plan pricing. d. Click 'Create.' Fee Schedule - Custom 1. Click 'New Fee Schedule' and select 'Custom,' click 'Continue.' 2. Complete the top portion of the screen. 3. When customizing a fee schedule, RevolutionEHR does not load any information for you. Activate a line by clicking within the field that is to be updated and input information. All fields within all sliders will need to be updated. 4. Click 'Create.' Page 5

8 Additional Features As Fee Schedules are created they will be listed in the left column of the screen. Example If needed, single click on a fee schedule and click 'Deactivate.' Example Page 6

9 Inventory 1. Access Inventory > VSP Products slider. Highlight a product category, click 'Import Product.' (Import all products within all categories that your practice sells. If your practice does not sell a product, there is no need to import it to inventory.) 2. Type 'VSP' in the "Manufacturer" field. (Brand and Collection fields are not used for VSP products; Model is an optional entry field.) Example Important Note: When importing items from the Lens Style category, enter "Any Single" for a more defined search when searching for single lenses. (Bifocal and Trifocal are listed by design: Flat top 28, Flat top 29, 7x28, 7x35, etc.) Example 3. Drag and drop the items your practice sells from the right column to the left column. (An item can also be moved from the right column to the left column with a double-click.) o o To move consecutive products: Windows: Click the first item, press and hold down the Shift key, and then click the last item. Drag and drop the entire list from the right column to the left column. Mac: Hold down the Command key, then click the items. Drag and drop the entire list from the right column to the left column. To move non-consecutive products: Page 7

10 Windows: Press and hold down the Ctrl key, and then click each item that you want to select. Drag and drop the entire list from the right column to the left column. Mac: Click the first item you want to select, hold down the Shift key, then click the last item. Drag and drop the entire list from the right column to the left column. 4. After a product has been imported into your VSP Product catalog, pricing must be entered. Review the pricing instructions below and complete product pricing as appropriate to each category situation. VSP Product Pricing To assist in the pricing of products we recommend you have the most recent copy of the VSP Product Index. This can be obtained by logging into Eyefinity > VSP Online > Manuals > VSP > Dispensing & Patient Options > Product Index. This information provides the appropriate Fee Options for all VSP products. AR Coating AR coatings are sometimes a combination of products that include AR and additional treatments like UV or scratch coat. For this reason, it is necessary to add the appropriate fee options to ALL AR products. Some lenses will only need the AR code, however, if the AR comes with other treatments like UV or scratch, you must also add those fee options. 1. Open an AR inventory item. 2. Click 'Edit.' 3. Enable the search icon to search for the Fee Option code and the Code/HCPCS, or, type the code directly into the field. 4. Complete the Retail Price for the add-on fee only, per lens. Example This example includes fee option, code and pricing for A/R and UV. 5. Repeat the process for each appropriate fee option. Page 8

11 6. Click 'Update.' Lens Style 1. Open a Lens Style inventory item. 2. Click 'Edit.' 3. Enable the search icon to search for the Fee Option code or Code/HCPCS, or, type the code directly into the field. 4. Complete the Retail Price for the add-on fee only, per lens. 5. Most Lens Styles require multiple Fee Options and HCPCS codes; as well as individual prices for each add-on, per lens. Example This example includes fee option, code, and pricing for progressive, hi-index, and transition. Note: When importing Lens Style products, you will find products that are the equivalent to the base lens: Any Single Vision Plastic, Flat top 28 plastic, 7x35 plastic, etc. You must import those products so they will be available in your VSP eyeglass order. However, because base lenses are already calculated, no fee option should be added for these lenses. Example Page 9

12 All Other Categories 1. Open an inventory item. 2. Click Edit 3. The Fee Option field will have an entry from the system. If necessary, access the search icon and change this field. 4. Complete the Retail Price for the add-on fee only - per lens. Example 5. Click 'Update.' Copy Inventory > For Multi-Location Practices 1. Copying data from one practice to another practice will only transfer the product; it DOES NOT transfer all the data WITHIN the product such as Fee Options, Codes, and pricing. 2. Click 'Copy' in the bottom right corner of the column of VSP Products. 3. Select the "Copy From" location and the "Copy To" location within the dropdown menus. 4. Enable the checkbox beside the category to copy. 5. Click 'Copy.' Page 10

13 Orders Instructions for Setup and Inventory must be completed before continuing with Orders. 1. Create an order. 2. Order Details slider: Complete all areas of the slider as you would any order, except, in the "Processor" dropdown menu, select "Eyefinity/RevAssistant." 3. Rx and Lens Information slider: Select the appropriate "Type" "Material", "Lens Style" and "Eye. Example The list of Lens Style options are pulled from the VSP Products Inventory and are filtered based on the Type and Material selections. "Eye" determines the quantity of lens add-ons that will appear on the Billing screen. Unless only one lens is being processed, OU should be selected. Base lens quantity is determined by the RX (i.e.: If an RX is written for one eye only, the base lens will have a quantity of 1. If an RX is written for both eyes the base lens will have a quantity of 2). Complete "Lens Measurements, Lens Options, Tints, and Coatings" as appropriate to the order. Note: Frame only and Contact Lens orders will not include this step. All other instructions remain the same. 4. Frame Information slider: Complete all areas of the slider as you would any order. If 'Patient' is selected for the "Source," the selected frame will not populate on the Billing slider. The frame Page 11

14 selected within the "Frame Product Selection" will populate in the Billing Preview section of the Billing slider. 5. Billing slider: a. If appropriate, associate an encounter to the order. The services must remain in the Unassigned tab in the encounter's billing screen in order to combine the services and materials onto one set of invoices, b. Click 'Update.' c. Click Edit. d. If an authorization was not obtained using RevAssistant, proceed to step f. e. If an authorization was obtained with RevAssistant, click the lookup icon to associate the authorization. If the authorization has not been obtained, click 'Authorize on Eyefinity.' (RevAssistant must be enabled to use this function. The user guide is available at Guide.pdf ) Example f. The data entered in steps g-i can be found in the details of the authorization. Example g. Check the appropriate benefit boxes (i.e. Exam Benefit, Frame Benefit, Lens Benefit, Contact Lens Benefit). Example Page 12

15 h. Click the look-up icon to associate the Fee Schedule. Select the VSP Fee Schedule from the modal and click 'Continue.' Example i. Enter the applicable Materials Copay, Allowance (frame or contact lens), and Wholesale Allowance (WFA) into the appropriate fields. If this is a contact lens order, select a "Contact Lens Reason" from the dropdown menu. Example j. Click 'Refresh Preview.' i. This action will populate the Billing Preview table and calculate Retail Cost, Total Cost, VSP Pays, VSP Chargeback, and Patient Pays. Any unassigned services from an associated encounter will be listed and reimbursement for these services will be calculated. If errors are present, a message will display in red text next to the "Add Row" button. All errors must be fixed before the Refresh Preview will Page 13

16 calculate correctly and for the Approve Order button to be available for use. Example NOTE: Reset Preview will clear any changes ii. iii. Correct any errors and click 'Refresh Preview.' Hover your cursor over the dollar amount in the VSP Pays, VSP Chargeback or Patient Pays to see a popover that will include more detailed payment information. Example iv. If the Covered column for an item is not correct, click into the column and check or uncheck Covered. Click Refresh Preview to recalculate. Example v. If information within the Code, Product/Service, VSP fee Option, Retail Cost or Covered columns is incorrect, click the appropriate row and edit the fields as needed. Checking Remember will update the VSP Product Catalog with these changes. If the product catalog should not be updated, do not check Remember. Click Refresh Preview to recalculate. Note: Frame and Base Lenses are not editable. Example Page 14

17 vi. If an item needs to be added to the Billing Preview, click Add Row. Enter Code/HCPCS, Quantity and press Continue. Click the newly added row and update any of the missing information. Click Refresh Preview to recalculate. Example vii. If an item should not be included in the Billing Preview, select the appropriate row and press Delete. Click Refresh Preview to recalculate. Example viii. If no errors are present or after errors have been corrected, the amounts for VSP Pays, VSP Chargeback, and Patient Pays will calculate and provide the estimate. k. Click 'Update.' l. If no further changes are needed, click 'Approve Order.' 6. Click 'Generate Invoices for VSP and Patient.' The invoices information is visible at the bottom of the screen. To open an invoice, click the look-up icon next to each invoice. Example Page 15

18 7. Follow the steps necessary to complete and submit the claim order in Eyefinity. When finished, close Eyefinity, and in RevolutionEHR update the order status to Transmitted and claim status to Marked as submitted. Page 16