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:

• California Medicaid: California Health Net providers who have not completed the annual compliance training on or after Oct. 1, 2025, must complete the training as soon as possible.*
• Carolina Complete Health and WellCare of North Carolina Integration: Carolina Complete Health and WellCare of North Carolina will combine into a single, statewide health plan effective April 1, 2026. The combined organization will operate under the name Carolina Complete Health.
• Ohio Medicaid: For OH MyCare claims submitted through clearinghouses, please submit directly to the ODM FI using Centene Vision’s Payor ID #V004202. EDI claims submitted directly to Centene Vision after March 15, 2026, will be rejected regardless of the date of service.

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

Beware of Fraudulent Payment Requests

There have been fraudulent communications sent via email to providers appearing to be from Centene Vision requesting payment. Please review the sender’s email address carefully before responding. All emails from Centene Vision will come from a @centene.com or @envolvehealth.com email address.

If you receive a communication that you are unsure about, please contact the customer service number listed in your Plan Specific to confirm whether any action is needed.

Comprehensive vs. Intermediate Eye Exam – Correct Coding Education

Intermediate and comprehensive ophthalmological services constitute integrated services in which medical decision making cannot be separated from the examining techniques used. Itemization of service components, such as slit lamp examination, keratometry, routine ophthalmoscopy, retinoscopy, tonometry, or motor evaluation is not applicable.

Comprehensive ophthalmological services (92004, 92014) describes a general evaluation of the complete visual system. The comprehensive services constitute a single service entity but need not be performed at one session. The service includes history, general medical observation, external and ophthalmoscopic examinations, gross visual fields and basic sensorimotor examination. It often includes, as indicated: biomicroscopy, examination with cycloplegia or mydriasis and tonometry. It always includes initiation of diagnostic and treatment programs. Therefore, ophthalmological services reported solely with refractive diagnoses (i.e. unaccompanied by complicating comorbidities that involve the initiation of diagnostic and treatment programs) should be reported as routine intermediate ophthalmological examinations (92002, 92012).

‘Initiation of diagnostic and treatment program’ includes:

• The prescription of medication*, and
• Arranging for special ophthalmological diagnostic or treatment services, consultations, laboratory procedures and radiological services.

*Prescription of lenses, when required, is included in 92015. It includes specification of lens type (monofocal, bifocal, other), lens power, axis, prism, absorptive factor, impact resistance and other factors.

Reference: AMA’s CPT 2026 Professional Edition (The only official CPT codebook with rules and guidelines from the AMA’s CPT Editorial Panel.)

Supporting Health Equity Through CLAS

Centene Vision has adopted the Culturally and Linguistically Appropriate Services (CLAS) Standards, as developed by the U.S. Department of Health and Human Services, Office of Minority Health. These standards serve as a key resource in supporting the delivery of culturally sensitive, high-quality care to diverse populations. To support providers in applying these principles in practice, we encourage participation in the Culturally Appropriate Care and Health Equity course offered by the Centene Institute for Advanced Health Education. This course explores how culturally appropriate care can improve patient outcomes, safety, and experiences in healthcare.

How to Create an Account and Register

If you have not set up a profile with the Centene Institute, click “Register” and select “Create New Account.” Complete all required fields and submit your information. Once logged in, return to the course page, select “Register,” and then click “Take Course” to begin.

Beyond Vision: A New Link Between Glaucoma and Cognitive Health

Recent findings suggest that open-angle glaucoma (OAG) is associated with a modest but significant increase in the risk of early-onset Alzheimer’s disease (AD) in adults aged 40–64 years. The association was observed more frequently in men, while no significant link was found in women.

Early-onset AD was also associated with several comorbidities, including depression, diabetes, hypertension, and excessive alcohol use.

Vision providers can support patient awareness by reinforcing the importance of routine follow-up, noting any reported changes in memory or cognition, and encouraging patients to discuss concerns with their primary care provider.

Source: Open-Angle Glaucoma Tied to Early-Onset Alzheimer’s Disease

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.

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.

Has a Change Occurred in Your Office?

If your office has had any recent changes, please visit the provider forms page and complete the form that applies to your situation. Keeping your information up to date helps members make informed decisions when choosing care.

Not sure if an update is needed? Use the Find a Provider tool at centenevision.com/fap to search for your profile. What you see is exactly what members see.

Professional Interpreters Support Better Member Care

It is essential to use trained medical interpreters when communicating with members who are non-native speakers. Relying on family members or office staff is not recommended, as it may lead to incomplete, incorrect, or misunderstood information. Using qualified interpreters helps ensure accurate communication and supports the highest quality of care for members.

Translation services are available to members at no cost to them or to you. When scheduling appointments, please make sure all the member's needs are identified so they can be accommodated. If TTY services are required, call the Customer Service phone number listed in your Plan Specific. Thank you for your dedication to meeting our members’ needs.

Source: Interpreter services and effect on healthcare - a
systematic review of the impact of different types of interpreters on patientoutcome

Timely Access to Care

Please refer to the chart below for guidance on patient access to care timelines. If you have any queries, please don't hesitate to get in touch with our Customer Service for assistance.

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.