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:

• Arkansas Medicaid: Beginning January 1, 2026, Medicaid vision benefits will be administered by the state. Centene Vision will no longer be administering benefits for Arkansas Total Care, but all claims with a date of service of 2025 will be processed by us.
• California Medicaid: California Health Net providers must complete the annual provider training by December 31, 2025.*
• Texas Medicare Advantage: Beginning January 1, 2026, El Paso Health is adding two new Medicare Advantage plans, Health Total and Health Giveback.
• Pennsylvania CHIP: Beginning January 1, 2026, Centene Vision will be administering vision benefits for PA Health and Wellness CHIP members.

* Registered California Medicaid providers are required to complete Annual Compliance training. The training is due December 31, 2025. If you have completed this attestation after October 1, 2025, no action is required. Please contact ebocompliancematters@centene.com with any questions. Link to training: centenevision.com/catrain

Claims Filing Made Simple: Online or by Mail

Providers have three easy options for submitting claims: online, electronically, or by mail.

• Online: Use the Eye Health Manager (EHM) at centenevision.com/logon to submit directly into our claims system. This method provides immediate confirmation of receipt. If you do not currently have access to the EHM, call Network Management at 800-531-2818.
• Electronic: Submit claims electronically through Change Healthcare using Payor ID 56190 (Centene Vision or Envolve Vision). For setup, call 800-845-6592.
• Mail: Send claims on an original CMS 1500 form. Ensure all information is complete and legible for processing. Mail to the address listed within the appropriate Plan Specific.

Choose the method that works best for your practice and ensure timely, accurate submissions.

Can Your Patients Find Your Practice?

Incorrect or missing details on the Find a Provider tool can make it harder for patients to locate your practice, schedule appointments, or even confirm that you're in-network.

Take a few minutes to look yourself up on the Find a Provider tool:

• Search for your name and practice location.
• Review your contact details, address, and office hours.
• Confirm that your specialties are correct.

If you notice any errors, update your information right away using the Online Provider Update Form.

Failing Vision Causes Eye Cells to Rewire

New research reveals that certain retinal cells can rewire themselves as vision declines in retinitis pigmentosa, a genetic eye disease that causes progressive blindness. Affecting millions worldwide, retinitis pigmentosa is a leading cause of inherited vision loss. While the disease often advances slowly, allowing some individuals to retain functional vision into middle age, scientists have long sought to understand how retinal circuits adapt to cell loss.

The study shows that retinal circuits preserve function through distinct adaptation mechanisms at different stages of disease progression. These insights could help researchers identify new therapeutic targets to maintain vision in patients with inherited retinal disorders.

"Our findings show that the retina adapts to the loss of rods in ways that attempt to preserve daytime light sensitivity in the retina," said senior author A.P. Sampath, Ph.D. of the Jules Stein Eye Institute. "When the usual connections between rod bipolar cells and rods are lost, these cells can rewire themselves to receive signals from cones instead. The signal for this plasticity appears to be degeneration itself, perhaps through the role of glial support cells or factors released by dying cells."

Source: Eye cells "rewire" themselves when vision begins to fail

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.

Clinical Policy Updates

Our clinical policies have undergone annual review, and many have been updated. Some of the changes include new ICD-10 codes for secondary angle closure glaucoma, multiple sclerosis, and thyroid orbitopathy. Below is the list of policies that have been updated. To stay up to date on all changes, be sure to use our Eye Health Manager provider portal or visit our policy page.

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 26,000+ 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.