Envolve Vision is a leader in exceptional, tailored vision benefits and services for Medicaid, Medicare, and Marketplace member products. Every quarter we share key news that you can use to best serve your patients.
Welcome Triple-S Medicare Advantage Members!
Effective August 1, 2025, Envolve Vision will administer vision benefits for Triple-S Salud Medicare Advantage members. As a contracted provider with Envolve Vision, you will be able to service these members under the current terms of your existing Envolve contract beginning August 1.
Note: Member eligibility records for Triple-S will be available in Eye Health Manager by the end of July.
Review A New Patient Coding Example
Scenario: A new patient presents for an examination and refraction. Patient is a Type I diabetic and agrees to fundus photography evaluation for retinopathy, no retinopathy is present. Patient orders a new frame with progressive lenses (RX OD: +4.00; OS +4.50; Add: +2.25), polycarbonate material and transitions. This is how it would be coded:
- New Patient Exam: 92002, 92004 or S0620 + routine diagnosis
- Refraction: if exam was coded with 92002 or 92004, add 92015 for the refraction + refractive diagnosis
- Fundus Photography: 92250 with E10.9 diagnosis (Type I Diabetes, without complications)
When the patient picks up their glasses:
- Frame: V2020 (frame) or V2025 (deluxe frame) (1 unit)
- Base Lens Code:
- OD: V2200 or V2300 (1 unit)
- OS: V2201 or V2301 (1 unit)
- Progressive Lens Add-On: V2781 (2 units)
- Polycarbonate Lens Add-On: V2784 (2 units)
- Transition Add-On: V2744 (2 units)
Additional reference for optical hardware coding: American Academy of Ophthalmology s Learn to Code: Optical Dispensing
Meet Your New Provider Relations Representative!
Envolve Vision would like to introduce our new provider relations representative, based in Puerto Rico. She has been with the company for nine years, with over five years of experience in healthcare operations and a strong background in provider relations, claims investigation, and issue escalation.
With the addition of a new representative, there are now three provider relations representatives in Puerto Rico.
Joselito Abrew 787-946-2275│Joselito.Abrew@EnvolveHeath.com
Shirley Elizondo 787-945-4798│Shirley.M.Elizondo@Centene.com
Raisa Figueroa 787-908-174│Raisa.Figueroaortiz@EnvolveHealth.com
Your Voice Matters – Tell Us How We Are Doing
Envolve Vision sends a Provider Satisfaction Survey annually to receive feedback on how we are doing and how we can better serve you. Providers are encouraged to give feedback regarding credentialing, customer service, utilization management, claims, coordination and quality of care, and general experience.
Surveys were sent to providers in June via the email we have on file for the offices. Please check your spam/junk folders as the email will be sent from an external source (Qualtrics). We look forward to hearing from you!
2025 Medicare Compliance Training
Thank you for participating with Envolve Vision s Medicare Panel. Please disregard this article if you have received confirmation of training completion.
To comply with the Health Plans training requirements related to First Tier, Downstream, and Related Entities (FDR), all Medicare-contracted providers must attest each year that they have completed the Medicare Compliance Trainings for themselves and their staff.
The 2025 trainings launched on June 16, 2025. For convenience, the 2025 trainings and attestation are located online as they were in prior years. Please visit the envolvevision.com/attestation.html website to access the required documents.
After you review the Medicare trainings, please fill out and submit the attestation on the vision website. Then you will have successfully completed the training requirements. On the website, you will receive an instant confirmation that your attestation was submitted. You will also receive a confirmation email at the email address you provide.
FOR PROVIDER GROUPS, we have included an option to submit individual provider information within your group (up to six practitioners) into the vision website form. You only need to submit for one location, as the training is tracked at the individual provider NPI level. It is not necessary to submit multiple addresses for the same providers.
If you have questions, please email our Compliance Team at EBOSIU@EnvolveHealth.com.
Protect Your Practice: FWA Reminders and Updates
Envolve Vision conducts regular audits and uses systems to analyze claims to identify possible Fraud, Waste and Abuse (FWA). If any FWA is detected, the Envolve Vision Special Investigation Unit will conduct a review that may result in actions against those who are found to have committed FWA. Actions may include:
- Provider education
- More rigorous Utilization Review requirements
- Recovery of monies previously paid
- Extrapolated overpayment calculation
- Reporting to appropriate payor and/or regulatory agencies (OIG)
- Termination from the Envolve Vision Network
The most common submissions of FWA:
- Unbundling of codes
- Upcoding
- Misrepresentation of services
- Claims for services not rendered
If you suspect another provider is inappropriately billing Envolve Vision Services or if a member is receiving unnecessary services, please contact Envolve Vision Services Fraud, Waste and Abuse hotline as indicated. We take all reports of potential FWA seriously and investigate all reported issues.
Fraud, Waste and Abuse Hotline Centene Vision Special Investigation Unit Email: CDVSIU@Centene.com Vision FWA Hotline: 866-685-8664 |
Always Check Member Eligibility
It is essential to review member eligibility before providing any services. This practice ensures that the services rendered are appropriately covered by the member s health plan, reducing potential reimbursement issues and ensuring compliance with regulations. Maintaining an eligibility verification process helps both providers and members. You can verify eligibility by logging into the Eye Health Manager or calling Customer Service.
Improve the Health of Diabetic Members
Help your patients with diabetes and reduce administrative burdens. Envolve Vision offers a dedicated HEDIS Training and Tips website to determine CPT II and other supplemental codes to use for diabetic retinal exams. Routine retinal evaluation is recommended to reduce the risk of diabetes-related blindness.
REMINDER: You may be eligible for a $10 CPT II reporting incentive. Please ensure your billing staff submits a billed rate of at least $10 to receive the maximum reimbursement for this incentive program. Review your fee schedule and remember to submit the appropriate CPT II codes referenced at HEDIS Training and Tips.
Is Your Practice Accessible?
To enhance the availability of healthcare services for individuals with disabilities, we invite you to participate in the Provider Accessibility Initiative (PAI) survey. It is vital that patients have the most accurate information about your practice s accessibility.
Your involvement is particularly helpful to those patients who already struggle with many health care issues. According to the CDC, approximately 1 in 4 adults in the United States and Puerto Rico has a disability. Individuals with disabilities are more likely to:
- Have depression
- Struggle with obesity
- Have diabetes
- Smoke
- Have heart disease
Improving access to care for these at-risk patients is more important than ever. Please complete this short PAI survey to help make sure our members can find your practice when they need you most.
No Referral Needed
When scheduling eye exams for patients, referrals from primary care physicians (PCPs) are not required when seeing a participating optometrist or ophthalmologist. Questions? Please contact Customer Service.
Geographic Atrophy on the Rise in 2025
Geographic Atrophy, a type of age-related macular degeneration (AMD), is becoming more common in older adults (1 in 5 individuals with AMD). Patients that have a family history of AMD and are smokers increase their risk of this condition. Please remind patients of the importance of regular visits for early diagnosis. While this is currently no cure, an early diagnosis can help slow progression.
Source: Geographic Atrophy: Causes, Symptoms, Treatment - American Academy of Ophthalmology
New Climate and Health Risks for Eye Care
There has been an increase in eye conditions due to climate change, including keratitis, pterygium, conjunctivitis, and cataracts. Cataracts, typical for those over 60, have become more common for people ages 15-49, especially in regions where a large portion of the population works in agriculture. This is due to increased heat and improper eye protection.
There are ways patients can protect their eyes from high temperatures. Remind them to take frequent breaks in heavily shaded areas when outside for extended periods of time. Additionally, wearing a hat with a sun visor and UV-filtered sunglasses can provide more protection from the sun s rays. Lastly, eating foods rich in vitamins A, C, and E such as avocados, almonds, strawberries, and salmon can also help strengthen the optic nerves.
Source: How Climate Change Threatens Eye Health
Vision Care by the Numbers
About Us
A subsidiary of Centene for more than 30 years, Envolve Vision has partnered with vision care providers across the country to administer eye care programs that meet the needs of our members. You are among 22,000+ unique eye care providers, including independent providers and popular retail chains, within our network. Thank you for partnering with us to provide quality vision services to your patients.