Vision Plan Responses to Recommendations for Temporary Relief
Find information on the responses to AOA's recommendations.
| AOA recommendation | Envolve | |
| Deadlines for recredentialing and/or revalidating doctors' credentials for vision plan networks. | NCQA has extended the practitioner and provider recredentialing cycle two months, allowing for a 38-month recredentialing period (CR 4). As Envolve is accredited through NCQA for credentialing and recredentialing, we cannot be more lenient than NCQA allows. | |
| Refrain from requesting doctors verify their credentials or directory information for three months. | Envolve will offer all leniencies extended to MCOs as a result of COVID-19, but cannot control validation process requirements, as these vary by plan and market. | |
| Provide a dedicated, single toll-free phone number, email address, and/or online form for doctors to voluntarily self-report temporary practice updates that can be added immediately to online network provider directories. | Envolve is not making temporary status updates to provider directories, but is instead encouraging members to verify office availability prior to seeking care. On our Find A Provider website, we encourage members to call offices to validate current work hours and availability. Providers who wish to self-report changes in office status should still reach out to existing toll-free lines as calls are tracked by market and health plan. | |
| Expedite new or pending network applications. | Envolve is committed to expediting new and pending applications through the process as quickly as possible. However, this is contingent on providers submitting all required and outstanding information. | |
| Limit patient cost sharing for out-of-network services at in-network amounts. | Any provider claim with a date of service beginning March 17 through June 30, 2020, that is billed with a place of service of 02, will have $0 member liability. Members enrolled in a High Deductible Plan (HSA) will still require member liability with the exception of the treatment for COVID-19. Out-of-network providers will be reimbursed at participating rates unless dictated otherwise by local requirements. | |
| Extend in-network benefits for patients seeing out-of-network doctors. | Envolve will allow services billed by out of network doctors. However, non-participating providers are still subject to appropriate verification (sanctions checks, W9 on file, state registration for Medicaid beneficiaries, except as relaxed by applicable state or federal guidance). | |
| Provide out-of-network doctors easy online access to information about out-of-network benefits. | Envolve will share in-network plan specifics with out-of-network providers upon request; the contact information on the member ID card can be used to reach Envolve customer service. | |
| Eliminate patient cost sharing for any testing or services related to COVID-19. | This service will be billed to the patient's health plan with no cost share obligations for the patient. | |
| Allow doctors to provide virtual services for established patients. | Any provider claim for urgent or emergent eye care with a date of service beginning March 17 through June 30, 2020, that is billed with a place of service of 02 will be allowed regardless of HPSA (rural) status, and will be covered per 1135 waiver eligibility. Services should be limited to medically necessary procedures of the eye and medical records should be kept appropriately. | |
| Allow doctor discretion to provide covered services to established patients via telehealth rather than in person, where possible. | Envolve is prepared to pay for telehealth services allowed by scope of practice and state authorities for medically necessary and urgent conditions. | |
| Recognize the authority of doctors to determine with an abundance of caution which components of comprehensive eye exams or other services may be safely delivered to patients in person, and not deny coverage merely because a component of the service could not be provided. | Envolve is prepared to pay for telehealth services when billed with appropriate AMA CPT/HCPCS codes. Envolve encourages providers to refer to current CMS and CDC guidance-as well as any applicable state directives-on the type and nature of care that should be rendered during this time. | |
| Take into account the examination limitations imposed on providers in the interest of reducing the risk of infection transmission in any subsequent record audits that include services provided during the national state of emergency, and impose no chargebacks or penalties as a result of those limitations. | Envolve recognizes the unique situation created by this pandemic and will consider these conditions in any future record audits. However, we cannot make a blanket guarantee that no chargebacks or penalties would be imposed if an audit is conducted and if wasteful or abusive practice trends are identified. | |
| Reduce or eliminate restrictions on patient access to care, such as prior authorization. | Envolve does not require prior authorization for any emergency services. | |
| Extend deadlines for claims submission. | Envolve will continue to follow CMS and state directives for timely filing requirements and will adjust as local requirement are modified. | |
| Extend deadlines for appeals and related requests for information. | Envolve will continue to follow CMS and state directives for timely filing requirements and will adjust as local requirement are modified. Many states have requested and/or received 1135 waivers from CMS that may adjust appeal and grievance or state fair hearing timeframes. | |
| Cease recouping funds from provider payments. | Envolve will limit recoupment to those situations required by applicable state or federal guidance, state agency request or recovery time limitations during the pendency of the emergency designation. | |
| Cease chargebacks. | Envolve will limit chargebacks to those situations required by applicable state or federal guidance, state agency request or recovery time limitations during the pendency of the emergency designation. | |
| Postpone audits and other requests for documentation. | Envolve will not issue any requests for documentation during the pendency of the emergency designation except to the extent necessary to comply with state or federal guidance, contract or state agency request. |