OptumHealth Update

New Process for Necessary Contact Lenses

OptumHealth has streamlined the process for Necessary Contact Lens authorizations.  Offices are no longer required to request a pre-authorization for contact lens materials when providing services to Necessary Contact Lens wearers.  After you verify member eligibility, just submit the updated Necessary Contact Lens Eligibility form along with your CMS-1500 form.  Click on attachment for the Necessary CL Form.


IMPROTANT INFORMATION: OptumHealth Private Label Products

Effective, May 1, 2012 OHV will begin classifying all private label products as “standard” under the formulary for progressive lenses and anti-reflective coatings. This new approach assures consistent point of service experience and eliminates the reimbursement issue with the L5 modifier (non-formulary progressive).  As of May 1 L5 modifier will no longer be valid on claims with dates of service after April 30, 2012.

TSO has requested that OHV classify the TSO MiraVa, MiraVa Plus, Lifestyle and Lifestyle Enhanced products in a category other than the “standard” category.  OHV will compare the features of the TSO private label products and align those with OHV categories.

OHV will notify TSO of the approved category before the end of April.  If you have any questions please contact Ann Deen at cadeen@tso.com or 214-704-1181.