Medicare

The Health Plan Medicare Advantage members (including SecureCare HMO, SecureChoice PPO and Dual-Eligible Special Needs Plan) utilize Superior Vision for routine eye care. Providers must be contracted with Superior Vision in order to treat Medicare Advantage members of The Health Plan.

Contact Superior Vision at superiorvision.com Monday – Friday 8 AM – 9 PM EST to determine if you are a participating provider or to request to join their network.

Feel free to contact THP’s Medicare Customer Service number at 1.877.847.7907 if you have any questions.

CMS Requests Provider Demographic Data Review/Attestation in NPPES 

 

The Health Plan strives to maintain an accurate provider directory to assist our members in locating a provider to treat their health care needs.

 

The Centers for Medicare and Medicaid (CMS) has made it their goal to increase the accuracy of provider directories.

 

CMS is requesting that providers review their demographic information in the National Plan and Provider Enumeration System (NPPES) registry, make necessary corrections and attest to the accuracy of the data.

 

The purpose is to reduce the need for payers, such as The Health Plan, to contact providers to verify demographic directory data.

 

NPPES has recently added the ability to enter multiple provider addresses where providers see patients for appointments.

 

Access the NPPES NPI registry here to verify and/or update provider demographic information and attest to the accurateness of the information.

 

There is no cost to providers to edit and certify NPPES information.

 

Please contact your practice management consultants should you have questions. Click here to access your rep’s contact information.

Medicare Advantage Vision Providers and Copays

THP vision providers (ophthalmologists and optometrists) may not collect a copay from Medicare Advantage members for Medicare covered eye exams or non–Medicare routine vision exams (including diabetic eye exams).

Vision benefits are as follows for Medicare Advantage members:

Covered services include:

  • Outpatient physician services for the diagnosis and treatment of diseases and injuries of the eye, including treatment for age-related macular degeneration. Original Medicare doesn’t cover routine eye exams (eye refractions) for eyeglasses/contacts.
  • For people who are at high risk for glaucoma, THP will cover one glaucoma screening each year. People at high risk for glaucoma include: people with a family history of glaucoma, people with diabetes, African-Americans who are age 50 and older and Hispanic Americans who are 65 or older
  • For people with diabetes, screening for diabetic retinopathy is covered once per year
  • One pair of eyeglasses or contact lenses after each cataract surgery that includes insertion of an intraocular lens (If you have two separate cataract operations, you cannot reserve the benefit after the first surgery and purchase two eyeglasses after the second surgery.)

Non-Medicare covered routine exams and eyewear, provided through the plan’s vision administrator and subject to plan coverage limits:

  • Vision exam – covered every year.
  • Routine eyewear (glasses or contacts) – covered every 2 years.

$0 copay for Medicare-covered eye exam.

$0 copay for one standard pair of Medicare-covered eyeglasses or contact lenses after cataract surgery.

$0 copay for non-Medicare covered/routine Vision exam.

$0 copay non-Medicare covered/routine eyewear.

Plan coverage limit for non- Medicare covered/routine eyewear:

$100 toward glasses (lens & frames) or contacts (including fitting exam).

THP has contracted with Superior Vision to administer the routine vision benefit for Medicare Advantage members. Vision providers must be contracted with Superior in order to provide routine vision care to THP Medicare Advantage members.