Managed Vision

Partner with Envolve Benefit Options for Vision Benefits

Envolve, through its family of companies, administers a fully customizable managed vision care plan to help reduce both client and member costs while still delivering the highest quality vision benefits available.

Our business solutions and expert industry experience offer our clients a competitive edge when it comes to receiving unparalleled vision benefit administration. 

Envolve partners with managed care organizations, health plans, states, and employer groups to design and administer eye care programs to meet the needs of their members.  We have experience with Commercial, Medicare, and Medicaid benefits.

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

Envolve employs an "any willing provider" strategy for network development. We market to every licensed vision provider in the service area for network participation and are constantly improving the efficiency of our network building systems.
Our vision benefits network features include:

  • 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:

  • 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
  • Board-Certified Ophthalmologists and Optometrists on staff for consultation and peer review

Our Utilization Management and Credentialing programs are NCQA certified. 

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 the 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 8,000 screenings 
  • Distributed more than 1,100 RX glasses at no cost
  • Distributed more than 2,000 pairs of reading glasses at no cost

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 analyzes your claim data to locate vision benefits plan abuse and overpayments. We have the ability to allow the client to maintain claim filing in house and employ our Utilization Management department and board-certified ophthalmologists to control your costs. We work diligently to manage facility and surgery costs by eliminating unnecessary claim disbursements while still providing a quality vision care plan to members.

We strive 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 and case management parser system

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