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April 28, 2017

Vision Services

 

Vision services, and materials, requiring a prior authorization should be submitted by fax to Medicaid on the appropriate request form: Early Exam PA Request, Glasses PA Request, or Contact Lens PA Request. It is  important that these forms are completed correctly, using standardized CPT Codes or HCPCS Codes for Vision Services which range from V2020-V2799. The Eye & Vision Provider Handbook lists the prescription criteria for items which require prior authorization. If Medicaid receives as incomplete or incorrectly filled out PA Request, it will be considered invalid and denied for improper documentation. 

For an order to be processed by Classic Optical, if one item in the order requires PA, then all of the HCPCS Codes pertaining to the order must be authorized. This includes frame, lens shape and/or material, and V Codes which must align with the prescription, as appropriate.

If the request does not meet state plan criteria it can be reviewed under EPSDT. Approval under EPSDT will be noted in the decision notes and an EP modifier will be added to the Code. Claims must be submitted using the EP modifier.

All orders for eyeglass lenses, frames, and contact lenses must be submitted to Classic Optical Laboratories, Inc.. Please see the Resources on the right of this page for further information. General questions, not PA Request Forms, may be sent to the Medical Care Unit’s email, medicalcareunit@dhw.idaho.gov.

The status of a prior authorization request may be checked online at the Molina Health PAS portal under “Authorization Status”, using your NPI, or by contacting Molina at (866) 686-4272. It is recommended that the vision provider check the AUTH closely to make sure the AUTH is correct before placing the order with Classic Optical. If the HCPCS Codes in the AUTH and the Codes for items being ordered do not match, the order will not process.  If an AUTH needs to be modified, please re-fax the PA Request form and ask for modification of an existing AUTH number. If there are questions regarding a Denial, click on the Notes, which will explain the reason for the Denial, or ask the Molina Customer Service Representative to read the Notes.

 

Contact

Vision Services

 Phone: 1 (866) 205-7403
Fax: 1 (877) 314-8779