Who we serve · Optometry
Optometry practices with a medical side. The medical eye visit, enrolled and billed on its own terms.
A glaucoma check, a diabetic eye exam or an eye infection bills to the patient's medical plan, not the vision plan. That needs medical enrollment for the practice and each optometrist, and claims built the way a medical plan reads them. We run that side.
Two kinds of plan, one exam room.
The vision plan and the medical plan never share a claim.
A vision plan pays for the routine exam and the glasses. A medical plan pays when the visit is about a medical problem of the eye. The same patient can carry both, and the reason for the visit decides which plan gets the claim.
Medicare treats a doctor of optometry as a physician for the services the state license allows, so an optometrist enrolls with Medicare like any other clinician. Medicare does not pay for the routine exam for glasses, or for the refraction, even when both happen during a covered medical visit. The claim has to separate the two.
Each commercial medical plan credentials optometrists on its own terms. Being in a vision network puts the practice in none of them, so a practice that has only billed vision plans starts this side from the beginning.
The medical side. Vision billing stays with you.
Medical enrollment, then medical claims.
- Enrollment
- The practice and each optometrist with Medicare through PECOS, your state's Medicaid and its plans, and the commercial medical plans your patients carry.
- Which plan gets the claim
- A written rule for your front desk: which visits go to the medical plan, which to the vision plan, and what the note must say for each.
- Claims and denials
- Medical claims built and followed until paid, and each denial traced to its cause and worked.
- Reporting
- What the medical side brings in, payer by payer, on the Friday board.
| Piece of work | Fee |
|---|---|
| The practice, each medical plan | $350 |
| Each optometrist, each medical plan | $250 |
| An optometrist's CAQH profile | $150 |
| Medical billing for the practice | By agreement |
What optometry owners ask us.
We are in every vision network. Are we enrolled with medical plans?
Not by that alone. A vision network and a medical plan's network are separate enrollments, even when the same insurer runs both. The review lists which medical plans have the practice and each optometrist on file.
Do you bill our vision plans too?
No. We run the medical side, where the enrollment and coding rules are the hard part. Your vision billing stays as it is.
Tell us which medical plans your patients carry.
We check where the practice and each optometrist stand with them. The review works from practice facts, never patient records.
We get back to you as quickly as possible.