Insurance (US)

Insurance (US)

The My Vision Express Insurance module streamlines billing, accounts receivable, and insurance claims processing. Required fields are automatically highlighted for the claim to be successfully processed, reducing errors and resulting in faster reimbursements. The patient insurance and order information that you captured in the Patient and/or Order module can be automatically transferred to the Insurance module.

This information can then be transferred to the Centers for Medicare and Medicaid Services’ CMS-1500 form (which supersedes the HCFA-1500), which contains additional fields for National Provider Identifier (NPI) numbers. The CMS-1500 information is printed in the appropriate boxes on preprinted laser forms.

My Vision Express also generates electronic claim files in both individual and batch mode in American National Standards Institute (ANSI) Accredited Standards Committee (ACS) 837P and Print Image format, which is accepted by insurance clearinghouses such as Emdeon®.

Create claims from directly within orders.

Create claims from directly within orders (click to enlarge).

Procedure codes are automatically processed (click to enlarge).

You're able to import Fee Schedules.

You’re able to manually add or import Fee Schedules (click to enlarge).

Authorizations

The Insurance module allows you to safely and securely store detailed benefits information, including copays and allowances.

  • Manage unlimited authorizations for medical and vision plans.
  • Obtain medical insurance eligibility from inside My Vision Express through our Gateway EDI® interface.
  • Integrates with Who Is Your Insurance, enabling you quickly identify your patients’ vision insurance and provides easy access to their benefits and authorizations.

Claims

Using the Insurance Claims feature, your practice will be able to streamline billing, as well as quickly and accurately process accounts receivable and insurance claims.

The intuitive screens highlight required fields, thereby reducing errors and helping your claims be successfully processed, with the end result being faster reimbursements. My Vision Express:

  • Automatically fills in claim details based on patient and sales records.
  • Submits claims individually or in batch.
  • Prints paper claims on CMS-1500 forms.
  • Submits claims with coding edits to third-party, integrated clearinghouses such as Emdeon and Eyefinity®.
  • Uses the latest ANSI ASC X12N 837P (005010A1) standard for electronic claims
  • Uses Physician Quality Reporting System (PQRS) codes which are added to your exams and to Medicare claims automatically
  • Looks up NPI numbers for providerss
  • Uses ICD-9 or ICD-10 diagnosis codes and quickly links corresponding codes.
  • Filters claims to be submitted by location, claim status, insurance company, creation date range, et cetera.

Fee Schedules

Automate the pricing of insurance options at order time by using fee schedules for insurance plans.

  • Specify wholesale, retail and material frame allowances
  • Enter copayments, contact lens allowances and dispensing fees
  • Price insurance options for spectacle lenses by procedure codes
  • Facilitates and speeds up insurance checkout process
  • Group frames, spectacle lenses, lens treatments and contacts to facilitate pricing

Payments

Easily allocate payments to outstanding insurance balances.

  • Post insurance and patient payments for multiple orders from the same screen
  • Search for outstanding balances based on patient name, order date range, order status, insurance company name, location, etc.
  • Allocate insurance payments to procedure codes
  • Write-off unpaid balances
  • Transfer balances between insurance and patient, or between insurance companies
  • Save your payment allocation transaction to continue working on it or modify it later

Electronic Remittance Advice (ERA)

Match insurance payments to the proper sales order, using an electronic remittance advice (ERA) file provided by your insurance or clearinghouse.

  • Import ASC X12N 835 (005010X221A1) files with ERA information.
  • Match amounts paid to procedure codes in claims.
  • Write-off and transfer balances.

5010 837P EDI Health Care Claim Professional (click to enlarge)