Medicaid/Avesis Customers in Paducah (PADUCAH OPTICAL ONLY)

***ATTENTION: This article applies to staff at the PADUCAH OPTICAL ONLY***

 Everything in this article is referenced in the "SVE Optical Insurance Manual." Please ask your manager to share that document with you if you do not currently have access to it in your Google Drive.

As of 09/15/2022, Success Vision Express of Paducah is in-network with Medicaid and Commercial plans for Avesis. For customers that have Medicaid, this includes the following plans:

HUMANA KY MEDICAID

AETNA BETTER HEALTH KY MEDICAID

WELLCARE OF KY MEDICAID

***BE ADVISED, WE CANNOT TAKE MEDICARE OR WELLCARE DUAL PLANS***

To verify a Medicaid customer's benefits, do the following:

1. Go to the "Avesis for PC" section of the "SVE Optical Insurance Manual" and click the blue link to take you to the Avesis provider home page

2. Click the black "Log In" button at the top right-hand side of the screen

3. Click the "Government Providers Log In" button in the bottom left of the screen

4. Choose the "Government (Medicare/Medicaid)" option from the drop-down menu under "Select a Login Type"

5. Enter username and password (both are in the SVE Optical Insurance Manual) and click "Login"

6. After the provider dashboard is finished loading, click the "Eligibility Search" option with the binocular icon

7. Enter the current date in the "Eligible As Of" field and the customer's information in the remaining fields in one of three ways:

A. Date of Birth, Last Name, First Name

B. Date of Birth, Member Number

C. Date of Birth, Social Security Number

8. Once the customer's information appears, click the "Usage" box

9. When the rest of the customer's information appears, scroll down to the "Accumulator" section and check to see if the "Spectacle Frame" and "Spectacle Lens" benefits are available by looking at the "Applied", "Remaining", and "Next Available Date" columns

10. The "Spectacle Frame" and "Spectacle Lens" rows should have 0 in the "Applied" column and have 1,2, or 4 in the "Remaining Column"

***If there is a 0 in the "Remaining" column next to the Spectacle Frame or Spectacle Lens and the "Next Available Date" shows a date for later in the current year or next year, then that benefit has already been used, the customer can't use their insurance for that benefit and they will have to pay cash for that benefit***

11. If the Spectacle Frame and Spectacle Lens benefits are both available for use, then scroll back up and confirm if the customer has either HUMANA KY MEDICAID, AETNA BETTER HEALTH KY MEDICAID, or WELLCARE OF KY MEDICAID

***The customer's benefits have now been verified and now you can move on to creating their frames and lens order using the criteria and requirements in the table and information below***

***All Medicaid plans will have the $33 dispensing fee added on, except for the "WellCare over 21" Medicaid plan***

***BE ADVISED THAT WE CAN NOT CHARGE TAX ON ANY OF THESE MEDICAID PLANS***

-The plan type needs to be inputted into the comment box on the customer's SVO chart

- If the customer wants to upgrade to something that a plan does not provide, they will be unable to use their Avesis and will need to be treated s if they are a cash patient (For certain instances, the Manager is welcome to upgrade the customer to a different lens, but we won't be able to bill Medicaid or charge the customer for the different lens, so the store would just have to eat the cost of the upgrade(s))

-Miscellaneous Fees (power charges, pro plus, etc.) cannot be added to any of these plans, except for the "Wellcare over 21" plan. The Misc. charges will function as normal with the "Wellcare over 21" plan.

- Since the power charge is automatically added in SVO, a manager discount code will need to be added on all plans, except the "Wellcare over 21" plan.

HOW TO VERIFY BENEFITS FOR CUSTOMERS WITH AVESIS COMMERCIAL PLANS

To verify a Commercial customer's benefits, do the following:

1. Go to the "Avesis for PC" section of the "SVE Optical Insurance Manual" and click the blue link to take you to the Avesis provider home page

2. Click the black "Log In" button at the top right-hand side of the screen

3. Click the "Commercial Providers Log In" button in the bottom left of the screen

4. Choose the "Commercial (Vision)" option from the drop-down menu under "Select a Login Type"

5. Enter username and password (both are in the SVE Optical Insurance Manual) and click "Login"

6. After the provider dashboard is finished loading, click the "Eligibility Search" option with the binocular icon

7. Enter the current date in the "Eligible As Of" field and the customer's information in the remaining fields in one of three ways:

A. Date of Birth, Last Name, First Name

B. Date of Birth, Member Number

C. Date of Birth, Social Security Number

8. Once the customer's information appears, click the "Usage" box

9. When the rest of the customer's information appears, scroll down to the "Accumulator" section and check to see if the "Spectacle Frame" and "Spectacle Lens" benefits are available by looking at the "Applied", "Remaining", and "Next Available Date" columns

10. The "Spectacle Frame" and "Spectacle Lens" rows should have 0 in the "Applied" column and have 1,2, or 4 in the "Remaining Column"

***If there is a 0 in the "Remaining" column next to the Spectacle Frame or Spectacle Lens and the "Next Available Date" shows a date for later in the current year or next year, then that benefit has already been used, the customer can't use their insurance for that benefit and they will have to pay cash for that benefit***

11. Scroll back up until you see a blue box with "Plan ID" and click the blue box to open another tab (you will need to turn off your pop-up blocker and click the blue box again if it doesn't open the first time).

12. A benefits sheet should appear with the frame allowance and different allowances and copays that the customer will pay for each add-on. If a "N/A" is next to an add-on, that means their plan does not cover that add-on and the customer pays the normal cash price for that add-on.