Managed Vision

Partner with Envolve Benefit Options for Vision Benefits

Envolve, through its family of companies, administers tailored managed vision care plans. Our vision benefit management services help reduce both client and member costs while still delivering superior vision benefits, including medical surgical vision care.

Our business solutions and expert industry experience offer our clients a competitive edge and unparalleled vision benefit administration. Through our fully customizable services, we can handle as much or as little of your vision plan management as you need, including complete medical surgical vision benefit administration. 

Envolve partners with managed care organizations, health plans, states, and employer groups to design and administer vision benefits plans to meet the needs of their members.  We have extensive experience with Commercial, Health Insurance Marketplace (HIM), Medicare, and Medicaid benefits.

Envolve’s vision benefits offerings include eye exams and eyewear including frames, lenses and contacts. Our managed vision network is comprised of independent providers and popular retail chains. We partner with over 22,000 unique vision providers in all 50 states.

Envolve employs an "any willing provider" strategy for network development. We market to every licensed vision provider in your service area for participation and are constantly developing our network to offer you the most comprehensive group of eye care providers available.

Our vision network offers:

  • Large, open panel
  • Independent providers
  • Popular retail chains
  • Mobile vision capabilities

On average, our focused medical/surgical vision care plan services result in a 1.25% reduction in the overall physician services med loss ratio for our clients. Envolve provides appropriate vision benefits care at the right cost at the most effective time.

Our medical/surgical vision benefits plan includes:

  • Board-Certified Ophthalmologists and Optometrists on staff for consultation and peer review
  • Moderation of costs associated with all types of eye care
  • Guidelines using the latest in evidence-based medicine to assist providers in making decisions about appropriate care
  • Limited pre-certification for the most over-utilized procedures to minimize interference between member and provider
  • Management of facility services
  • Claim accumulators for frequently abused codes
  • Retrospective review via data analytics and focused record review to improve cost and care
  • Provider profiles and trend analysis to compare practice patterns
  • Continuous two-way communication with providers

The National Committee for Quality Assurance Certified Vision Care Plan (NCQA) is an independent 501 non-profit organization in the United States that works to improve health care quality through the administration of evidence-based standards, measures, programs, and accreditation. 

Our Utilization Management and Credentialing programs are NCQA accredited.

Envolve works with vision care plan providers and our health plan partners on new and innovative ways to increase HEDIS and Stars scores. Some of our most successful programs include:

  • Making outreach calls from our call center to diabetic members who are non-compliant for the DRE measure to assist them with scheduling their eye exam. Our representatives use a pre-approved script and our call center has over a 98% effectiveness rate in exams scheduled.
  • Coordinating transportation services for members to assist them in getting to their eye care appointment.
  • Working with providers to follow up with diabetic members they have seen in the past to schedule their diabetic retinal exam.
  • Reminding providers through unique technology included in our web portal to bill the 3072F code at the point of checking eligibility and during the claim filing process. Envolve increased filing of 3072F by 1000% in some cases. HEDIS/Stars credit can be obtained via this administrative data.

“SeeMore,” the Envolve Vision Van, provides screenings for children and adults who might not otherwise receive them, and promotes the importance of eye care. As a client of Envolve, we’ll bring the mobile vision clinic to you! Doctors and technicians accompanying the van perform vision screenings free of charge to patients. While we see adults and help anyone in need, children (ages 5 – 18) are of particular focus for the vision van services.  

The mobile vision unit includes:

  • Screening tools to test vision outside the van
  • Equipment to perform basic vision exams inside the van
  • Informational handouts about eye health and the importance of eye exams

Since the inception of the SeeMore program in May 2015, we have:

  • Traveled to more than 20 states
  • Performed more than 12,000 screenings 
  • Distributed more than 3,700 RX glasses at no cost
  • Distributed more than 4,000 pairs of reading glasses at no cost
  • Provided aid to displaced Texas residents after Hurricane Harvey

The Vision Van brings needed vision services to individuals. Eye care facts: 

  • 4.3 billion people in the world need visual correction, and 2.4 billion people do not receive it
  • Somewhere in the world, someone goes blind every five seconds
  • By age 65, one in three Americans has some form of vision-impairing eye disease
  • People with diabetes are 25 times more likely to become blind than people without diabetes
  • Nearly three million people have glaucoma, but half do not realize it because there are often no warning symptoms

To learn more about where the Vision Van has been and where it is going, visit our News & Events section.

Cost Saving Managed Vision

Envolve will analyze your claims data to locate vision benefits plan abuse and overpayments. We  enable our clients to maintain network and claim filing functions in-house while employing our Utilization Management department and board-certified ophthalmologists to control costs. We can provide full medical surgical vision management, or you can contract and credential your own medical surgical eye care network and pay claims as usual; whichever you prefer. Either way, we work diligently to manage facility and surgery costs by eliminating unnecessary claim disbursements, while still providing a quality vision care plan to your members.

Envolve strives to lower the med loss ratio with our state-of-the-art business systems and information technology by employing:

  • Evidence-based medicine
  • Claim accumulators for frequently abused codes
  • Retrospective review via data analytics and focused record review
  • Provider profiles and trend analysis to compare practice patterns
  • Board-certified medical directors

Contact Us

Send us your information to talk to a representative.