Promoting and protecting the health and safety of all Idahoans
Español    Idaho.gov    About Us    Contact Us    Careers   
December 12, 2018

Vision Services

Effective October 1, 2018, National Vision Administrators (NVA) and Classic Optical, its partner optical laboratory, are very pleased to announce that we will be administering the eyeglass and contact lens vision supplies for state of Idaho Medicaid members.

NVA has been in business over 30 years and provides services to over 7.5 million members across the country. NVA also has expertise in administering the vision benefits for the Medicaid population, currently managing over 200,000 lives.

Classic Optical will continue to manufacture the lenses, however all lab orders and request for prior approvals will be administered by NVANVA will be sending additional information out to optical providers in the coming weeks.  If you have questions please contact the program specialist by phone at 208.364.1824 or by email at medicalcareunit@dhw.idaho.gov

Vision  materials requiring a prior authorization should be submitted by fax to NVA on the appropriate request form: 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 NVA receives an incomplete or incorrectly filled out PA Request, it will be considered invalid and denied for improper documentation. 

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

For participants under the age of 21, if the request does not meet state plan criteria it can be reviewed under the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) rule. 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 NVA. Please see the Resources on the right of this page for further information. General questions, and exam/fitting fee 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 DXC Technology portal under “Authorization Status”, using your NPI, or by contacting DXC Technology 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 NVA. 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 DXC Technology Customer Service Representative to read the notes.

 

Contact

Vision Services

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