Please review your OptumHealth EOBs carefully. When the contact lens benefit is higher (6 box, 8 box, etc.) the OptumHealth system pays for 3 boxes of MONTHLY PLANNED REPLACEMENTS, not 4 boxes. It is a known issue there is problem however there is not an estimated timeline for resolution. When the provider recognizes an adjustment is necessary, please follow the instructions on page 12 of the OptumHealth Network Administration Manual, which is available online. Indicate “MONTHLY PLANNED REPLACEMENT UNDERPAID” and the claim will be adjusted to pay the 4th box of contact lenses.
Note: The request for adjustment for Plan Replacement Contact Lenses must be submitted on paper (CMS1500) to OptumHealth.
If you have any questions please contact Ann Deen at 214-704-1181 or firstname.lastname@example.org.
OptumHealth Claims Clearinghouse
OptumHealth Vision accepts electronic claim through the following clearinghouses:
- Relay Health
- FGA, Inc.
You should call your contact at your clearinghouse to set up your practice for electronic submissions. OptumHealth Vision payer ID is 00773.