New! OptumHealth Announces Changes Effective June1, 2012

There are several big changes effective June 1: a) contact lens formulary changes, b) all contact lens claims must have a modifier, and c) the private label equivalents of formulary contacts must be submitted as covered contacts.

CL Added to the Formulary:

  • Acuvue Oasys
  • Dailies Aqua Comfort Plus, Focus Dailies Toric, Dailies Progressive, ProClear 1-Day and Acuvue One-Day Moist.  Note: These are 30-pack boxes, NOT 90-pack boxes.

Remove from Formulary:

  • Bausch & Lomb Pure Vision

New Requirement:  All private label versions of formulary lenses must be submitted as Covered Contact Lenses.

New Requirement: A contact lens modifier must be submitted on all contact lens claims.  There is a short transition period to give providers time to change their processes internally.  Use the modifiers beginning June 1.  Starting July 1, contact claims without a modifier will be rejected.

A June 1 contact lens formulary is attached for reference; it will be available online beginning June 1.  The current modifier is also attached for reference.

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