Centene Vision Services 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.

Local Market Reminders

Below are important upcoming changes:

• Mississippi Medicaid – As of July 1, 2025, Centene Vision now administers vision benefits for Magnolia Health members enrolled in the Children’s Health Insurance Program (CHIP).

Your Voice Matters – Tell Us How We Are Doing

Centene 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!

Have You Completed the HHS Cultural Competency Training?

Centene Vision is dedicated to delivering eye care services that are culturally and linguistically suitable, upholding the dignity and value of every individual member. These services are intended for individuals regardless of age, gender, race, color, religion, sexual orientation, and/or national origin, disability, mental or physical disability, or limited English proficiency.

We place emphasis on providing exceptional eye care through culturally competent staff, providers, and contractors. The organization encourages the nurturing of positive relationships between providers and members, promoting fair and equal treatment while increasing cultural consciousness.

Furthermore, we embrace the Culturally and Linguistically Appropriate Services Standards, as formulated by the Department of Health and Human Services, Office of Minority Health. These standards serve as a crucial resource in providing services that are attuned to cultural sensitivities.

We encourage participating providers to complete the U.S. Department of Health and Human Services Physician Practical Guide to Culturally Competent Care, which equips healthcare professionals with the skills necessary to better treat the diverse populations that they serve.

Protect Your Practice: FWA Reminders and Updates

Centene Vision Services conducts regular audits and uses systems to analyze claims to identify possible Fraud, Waste and Abuse (FWA). If any FWA is detected, the Centene 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 Centene 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 Centene Vision Services or if a member is receiving unnecessary services, please contact Centene Vision Services Fraud, Waste and Abuse hotline as indicated. We take all reports of potential FWA seriously and investigate all reported issues.

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 online through Eye Health Manager or calling Customer Service.

Improve the Health of Diabetic Members

Help your patients with diabetes and reduce administrative burdens. Centene Vision Services 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.

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.

REMINDER: Glaucoma disproportionately affects Black and Hispanic individuals. They are more likely to develop vision loss and experience blindness from glaucoma than White individuals.

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 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.

PAI SURVEY

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

Clinical Policy Updates

The clinical policies below have been updated recently. To stay up to date on all changes, be sure to visit our Eye Health Manager provider portal or centenevision.com/policies.

Vision Care by the Numbers

About Us

A subsidiary of Centene for more than 30 years, Envolve Benefit Options, doing business as Centene Vision Services, 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.