EmblemHealth Vision Services Program

Date Issued: 11/10/2016

Starting January 1, 2017, contingent upon approval by the New York State Department of Health, EmblemHealth will be introducing a new eye care program, the EmblemHealth Vision Services Program (EHVSP), in partnership with EyeMed Vision Care, LLC (EyeMed) and Comprehensive Professional Services (CPS). This program will replace Davis Vision, GVS, Eye Care Advantage and all other vision care agreements for all EmblemHealth members.*

EyeMed will administer all routine exams and the dispensing of hardware based on the member’s benefit. EyeMed will also be responsible for provider network management, credentialing, claims processing, and grievance and appeals. (Note one exception: EmblemHealth will remain responsible for all Medicare grievances and appeals.)

Plan Participation Implications
As of January 1, 2017, the Carve Out Vendor provision of your participation agreement(s) will apply to routine vision services only. These agreements, or sections thereof, will remain dormant until such time as our relationship with EyeMed/CPS changes and we notify you of our intent to reinstate your direct agreement(s) with us. All other terms and conditions of your Participating Provider Agreement(s) with EmblemHealth, including fee schedules, will remain in effect for all other networks and benefit plans.

To provide routine vision care for members served by the EHVSP, you are required to participate in the EyeMed network and must have an EyeMed Agreement. The terms of the EyeMed Agreement will supersede the agreement(s) you have with EmblemHealth. The fees for eye exams and hardware will follow EyeMed’s schedule.

To simplify the EyeMed application process, please make sure your CAQH information is current, accurate and complete. You can expect to hear from EyeMed soon with an invitation to join their network.

Contracting with EyeMed
To contract with EyeMed, or submit questions regarding the EHVSP program or reimbursement, please email EyeMed at prcontract@eyemed.com. To learn more about EyeMed, visit eyemedinfocus.com. Once you are contracted, you may logon to EyeMed’s website to review your contract, access the Provider Handbook and download copies of forms and billing instructions.

For information regarding member eligibility, please visit our website at emblemhealth.com.

*This program will serve members in plans underwritten by HIP Health Plan of New York (HIP) and HIP Insurance Company of New York (HIPIC) as well as members managed by Group Health Incorporated (GHI).