Refraction Claims Can be Submitted to EyeMed for Nearly All Plans
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While it’s true EyeMed does not typically coordinate benefits, we will pay for refraction if a member’s medical plan denies the refraction portion of the eye exam, as long as the member is eligible for eye exam benefits. The only exceptions are Tufts Health Plan and Lockheed Martin. Whether the member’s plan is EyeMed or Blue View Vision, please apply this process.
To file a claim for the refraction, first file the eye exam claim with the medical plan. After the refraction is denied, submit a CMS 1500 form to us with a copy of the denial. We’ll reimburse up to the U&C for the refraction according to the member’s exam benefits. Please note this will use the member’s entire eye exam benefit for the plan year.
Our official refraction only policy is published in the Provider Manual. If you have questions or need assistance, call customer care at 888.581.3648.
Send your refraction-only claims to: Fax: 866.293.7373
PO Box 8504
Cincinnati, OH 45040