EyeMed's Commitment to Provider Transparency
EyeMed believes that high quality and affordable health and vision care can only be achieved through a transparent and timely exchange of information between providers, patients and managed care organizations. We're committed to transparency and seek in-network providers that align to this objective. To deliver great care to their patients, and our members, we know providers need clear information, timely support, and transparent updates.
Our Commitment to Provider Transparency provides visibility into the principles that guide how we communicate with and support providers. This commitment includes 5 core principles:
1. Transparent contracting and documentation
We believe providers should always understand their contractual requirements and fee schedules and have prompt notice of any changes and/or updates.
This guiding principle ensures that when changes and/or updates are made to a provider agreement, contracted rates, the provider manual, or associated provider documents, we notify providers a minimum of 30 days in advance, and in most cases 90 days, based on state regulatory requirements. Communications explain changes directly or – where applicable – link to all updated documents. This includes our Provider Manual which contains a detailed cover letter with an overview of any updates and associated page numbers for ease of reference.
We have proactively communicated updated contracts to more than 20,000 tax entities over the last 48 months 1 in order to ensure contract clarity and awareness to our provider network.
2. Efficient and clear credentialing
We believe in a credentialing process that's timely and supported by regular status updates, real-time progress tracking and easy access to credentialing or recredentialing dates.
Providers that join EyeMed's network complete credentialing in an average of 15 days and often faster when their CAQH profile is up to date. Providers can check their credentialing status 24/7 on inFocus by viewing EyeMed's credentialing status tracker. They'll receive email updates as they move through the process and upon completion. Once credentialing is complete, providers receive a welcome letter with quick links and onboarding resources to begin servicing EyeMed members. Credentialing dates are also always available in the EyeMed online claims system for quick reference.
With an average 95%+ credentialing approval rate and a typical 15 day turnaround 2, EyeMed's credentialing process is fast and clear.
3. Open engagement and comprehensive education
We believe clear communications and transparency requires ongoing engagement, strong connections and a flow of educational resources.
We offer a variety of engagement methods for providers to ask questions, submit inquiries, or request copies of contracts through our specialized provider support team, dedicated provider phone line, or our online contact form. We also facilitate direct, in-person interaction with in-network providers and EyeMed provider experience experts or one of our Optometrists on staff, most of who still practice. You can find our team at large industry events, regional optometric association meetings or even helping facilitate a course at an Optometry School. We always value provider feedback and continue to seek new ways to engage and communicate with the provider community.
In addition to one-on-one conversations, we know it's equally important for providers and their staff to have access to tools and resources that allow them to quickly self-serve. That's why our providers have access to a comprehensive provider communications portal and why we proactively execute outreach campaigns that deliver educational information, such as job aids, FAQs, and instructional videos, to keep providers informed, engaged, and supported.
Our team of focused, subject matter experts answer provider calls on average within 30 seconds 3. We know providers and staff also find value in our provider communications portal, as proven by more than 100,000 visits to the site annually 4.
4. Real-time access to member benefits and eligibility
We believe network providers should be able to quicky and easily service patients, including locating and confirming the relevant, up-to-date eligibility and benefit information they need.
Through EyeMed's secure online claims system, network providers can look up and verify a member's vision benefit and eligibility at the time of service. Capabilities within the portal also allow providers to price a claim in real-time. We send email notifications and update inFocus regularly to inform providers of unique plan designs and new clients so they're proactively updated even before they see patients in office.
The EyeMed online claims system enables more than 240 million member searches per year 5, demonstrating the usefulness to providers in their day-to-day practice.
5. Transparent member resources and communication
We believe that leading the way in provider transparency also requires a transparent member experience that enables members to easily use and understand their vision benefits.
We help members understand their benefits through informative resources from the start by providing them a welcome kit with a complete listing of their plan details. Our members have 24/7 access to eligibility and benefit information online and our member portal includes a cost transparency tool to help them understand potential out-of-pocket costs at the time of their appointment. We also encourage network providers to incorporate details of their practice and location in our doctor search tool – including detailed information such as specialty, languages spoken, accessibility, hours and scheduling, doctors available at a location, gender, and products offered.
We deliver an average of 34 million messages annually 6 focused on reinforcing the importance of an eye exam, helping members understand their benefits, and encouraging continuity of care with their doctor.
Transparency guides how we connect, communicate, and support providers and members. By sharing information openly and keeping conversations clear, we can create a more informed, connected eyecare experience. We value the insights and ideas of our provider network as we continue advancing transparency and collaboration across the industry.