Supporting Eye Care Professionals

Superior Vision accepts HIPAA compliant 270/271 transactions. For providers requiring support on directions on how to submit a claim electronically and options, please call Customer Service at: 1 (877) 235-5317

Visit the forms page on the Provider Resource Center.

Visit the forms page on the Provider Resource Center.

Superior Vision selects highly-qualified ophthalmologists and optometrists for our network via an extensive application and National Committee for Quality Assurance (NCQA)-certified credentialing process.

Superior Vision collects, validates, and submits all documentation, history and quality data for review by the Credentialing Committee. Source verification of education, licensure, board certification, and DEA registration (where applicable) is obtained, and the National Practitioner Data Bank is queried for all applicants. The Credentialing Committee conducts an assessment of each eye care professional’s credentials, based upon pre-established guidelines of professional qualifications and office qualifications deemed necessary to provide quality patient care.

The credentialing and recredentialing of eye care professional is ongoing to ensure quality of care provided by our network eye care professionals. Recredentialing, conducted every three years, is based on a review of updated documentation (licensure, National Practitioner Data Bank inquiry, malpractice history, etc.), as well as reports generated through the patient satisfaction feedback mechanism and Superior Vision’s Quality Assurance Program, including site visits.

Recruiting efforts may include mailing eye care professional applications and recruitment materials with telephone or email communications. Names and addresses of potential practitioners and eye care professionals may be drawn from, but not limited to, the following sources:

• State Boards of Optometry
• State Optometric Associations
• State Licensing Boards
• Professional directories
• Internet searches by medical occupation
• Counsel for Affordable Quality Healthcare (CAQG) database
• The Blue Book of Optometrists
• Databases maintained by Superior Vision
• Client or member recommendations

When expedited eye care professional recruitment is necessary (particularly to prevent an interruption of patient care), an eye care professional recruitment associate may telephone a practitioner directly, and encourage the practitioner to submit an application. The associate would typically:

• Describe Superior Vision’s role as an administrator of vision care plans, and specify the potential client groups that the practitioner would serve.
• Explain how the Superior Vision plan is administered, and provide details on fees and reimbursement schedules.
• Obtain minimal information about the practitioner’s experience and qualifications. If both meet Superior Vision’s screening criteria, the representative would encourage the potential practitioner to complete and return an application. The representative will briefly describe the credentialing process.
• Conclude the conversation, by stressing the benefits of participating in the Superior Vision network, and the expectation that it will be a mutually satisfying relationship.

Criteria for recruitment decisions
Recruitment decisions are not based upon race, ethnicity, gender, age, or sexual orientation. Superior Vision does not charge practitioners any membership or administrative fees, nor is any portion of schedule payment withheld. Superior Vision does not discriminate against eye care professionals who serve high-risk populations, or specialize in conditions that require costly treatment.

Recruitment decisions are made solely on the basis of a practitioner’s qualifications, quality of care, and geographic need of the network. Oversaturation is avoided to ensure each practitioner an adequate share of the market.

Yes. Should you wish to receive a state or health plan specific network access plan, please contact Superior Vision provider relations, at 1 (800) 879-6901.

For details, please click here (PDF).

For details, please click here (PDF).