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.

Humana Puerto Rico No Longer Being Offered in 2026

Humana will discontinue their Medicare plans in Puerto Rico beginning January 1, 2026. All members currently enrolled in Humana Puerto Rico health plan will be selecting one of the other three Medicare Advantage plans offered in Puerto Rico during the open enrollment period (MCS Classicare, MMM of Puerto Rico, Triple-S).

Please continue submitting any claims for Humana Puerto Rico with dates of service prior to January 1, 2026, to Envolve Vision. This change does not affect your participation with Envolve Vision providing vision services to MCS Classicare, MMM of Puerto Rico, or Triple-S members.

Provider Manual Updates

As a reminder, yearly updates are made to the Puerto Rico Vision Provider Manual, so always check the EHM at envolvevision.com/logon for the most updated version. Please refer to the manual, along with the custom Plan Specific for your particular state and product, before providing services to members.

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.

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.