Vision and eye health solutions

Your all-in-one solution to routine vision, medical claims review and medical management.

A member-centric approach to vision and eye health

Our continuum of vision solutions helps ensure quality and appropriateness of care. It all starts with routine vision, which typically covers annual eye exams and eyewear.This is usuallly where things stop, but we go a step further for you by identifying and eliminating reimbursement for duplicate procedures, errors related to improper coding, etc. We then finish the continuum with medical management for services such as surgeries and injectables.

Protocols for vision services from routine exams to surgeries, change at a rapid pace. Most health plans do not have the internal resources to monitor and act on these changes. At Superior Vision, that is our only focus.

Graphic displaying routine vision, medical claims review and medical management

Start by learning about our routine vision capabilities below.

A member-centric approach to vision and eye health

Our continuum of vision solutions helps ensure quality and appropriateness of care. It all starts with routine vision, which typically covers annual eye exams and eyewear.This is usuallly where things stop, but we go a step further for you by identifying and eliminating reimbursement for duplicate procedures, errors related to improper coding, etc. We then finish the continuum with medical management for services such as surgeries and injectables.

Protocols for vision services from routine exams to surgeries, change at a rapid pace. Most health plans do not have the internal resources to monitor and act on these changes. At Superior Vision, that is our only focus.

Graphic displaying routine vision, medical claims review and medical management

Start by learning about our routine vision capabilities below.

Routine vision programs: Why offer them?

Annual eye exams and corrective eyewear are essential components to member health. In fact, American’s who have vision coverage are more likely to live a healthier lifestyle (National Association of Vision Care Plans, 2017).

Our members have easy access to quality care through our broad network of providers in a range of settings – from local, independent providers to large retail optical chains. Ensuring members easy access to quality care with Superior Vision can help drive improvements in HEDIS/Stars scores.

  • Includes routine eye exams and corrective eyewear (frames, lenses, contact lenses, etc.)
  • Promotes early detection and treatment of chronic conditions

“The incidence of chronic disease is driving up the cost of related conditions like eye care.”

National Center, Chronic Disease Prevention

Early diagnosis and treatment of chronic conditions
Source: Vision Source

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Next, learn about the benefit of reviewing medical claims.

Cost savings through medical claims review

Our claims review process is based on nationally-recognized guidelines. Our robust process identifies and mitigates incorrect CPT coding to reduce health plan spending.

  • Identifies and eliminates reimbursement for unnecessary or duplicative diagnostic procedures
  • Reduces medical spend by eliminating costs associated with inappropriately-billed procedures

Examples of incorrect billing

Refraction test and routing eye exam billed separately

Fundus photography used without medical documentation of relevant disease

Visual field tests conducted without documented medical necessity

Overuse of extended ophthalmoscopy and lack of relevant findings in retinal drawings

Our solution

Superior Vision’s program is based on nationally-recognized guidelines, including NCCI, AMA, AAO and AOA.

Superior Vision’s program is based on nationally-recognized guidelines, including NCCI, AMA, AAO and AOA.

Savings are evident

20%+

based on clinical guidelines –

boosted savings for health plans

Finally, learn about the benefits of medical management.

Improve vision care and reduce costs

Superior Vision’s medical management program delivers quality care while driving cost savings and ensuring regulatory compliance.

Our program encompasses:

  • Latest in evidence-based medicine to assist providers with care decisions
  • Board-certified ophthalmologists and optometrists on staff to review requests and ensure members receive quality care
  • Medical management platform based on clinical guidelines
  • Quality assurance program
  • Extensive performance management
  • Retrospective data analytics
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