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Provider Manual

Optical - Eyewear Order Guidelines

Last Updated on March 05, 2021

Vision Exams
Medical vision services, including but not limited to, preventive exams, office visits, cataract surgery and contact lenses should be billed to Security Health Plan. There is no limit to the number of medically necessary exams and visits.

Frames & Lenses
Security Health Plan is contracted with Classic Laboratories, Inc. (Classic Optical) to supply our BadgerCare HMO members with frames and lenses. Affiliated vision providers are required to use Classic Optical to order frames and lenses for Security Health Plan BadgerCare members. Some services may require prior authorization through Security Health Plan. Please see “Prior Authorization” section below.

  • Security Health Plan and Classic Optical follows FowardHealth guidelines for coverage of frames and lenses.
  • Generally, prior authorization is not required for one contracted pair of eyeglasses and one contracted replacement eyeglass component (frames and lenses) with the same prescription per member per 12-month period.
    • Prior authorization is required for eyeglasses beyond the limit of two with the same prescription per member per 12-month period.
    • Prior authorization is required for all non-contracted eyeglasses and eyeglass components.
  • Security Health Plan will reimburse vision providers at the current Medicaid fee for fitting and dispensing the glasses.

To view applicable ForwardHealth Topics (listed below), see the ForwardHealth Provider Manual
https://www.forwardhealth.wi.gov/WIPortal/
         A. Click Online Handbook
         B. Choose I Accept radio button and Submit Agreement
         C. For user type, select Provider
         D. For program, select BadgerCare Plus and Medicaid
         E. For service area, select Vision
         F. Click Advanced Search
         G. Enter appropriate topic number and click Search

  • An Overview – Topic 2264
  • Contract Frame and Lens Replacements – Topic 11879
  • Dispensing Services – Topic 2267
  • Eyeglasses and Components Not Available Through the Medicaid State Purchased Eyeglass Contract – Topic 11878
  • Frames Available Under the State Purchased Eyeglass Contract – Topic 2273
  • Lenses Available Under the State Purchased Eyeglass Contract – Topic 2274
  • Noncovered Vision Care Services – Topic 11277
  • Noncontracted Materials – Topic 2281
  • Prior Authorization Request Form – Topic 448
  • Prior Authorization Request Form Completion Instructions for Vision Services – Topic 2276
  • Repair Services – Topic 2271
  • Replacements – Topic 11297
  • Replacements Under the State Purchased Eyeglass Contract – Topic 11877
  • Requesting Prior Authorizatoin for Frames and Lenses – Topic 11337
  • Services Requiring Prior Authorization – Topic 2282
  • State Purchase Eyeglass Contract – Topic 2275
  • Upgraded Eyeglasses – Topic 11317

Placing an order for frames and lenses:

  • Online through Classic Optical’s secure, program-specific website (www.classicoptical.com)
    • If you don’t have an online account with Classic Optical, call customer service at (888) 522-2020 to obtain a user account and login instructions.
  • Mail to: Classic Optical Laboratories, Inc.
    P.O. Box 1341
    Youngstown, OH 44501
  • Fax: (888) 522-2022

Contact information for Classic Optical:

  • Phone: 888-522-2020
  • Monday–Friday, 7:00 a.m.–7:00 p.m. Central Standard Time

Contact Lenses
Contact lenses do not need to be filled through Classic Optical. Claims should be submitted to Security Health Plan.

Contact lenses, including replacement lenses, are covered without prior authorization for members who have a diagnosis of aphakia or keratoconus or if the contacts are being used as a therapeutic or bandage lenses.

Please see ForwardHealth Topic 4519 for a list of applicable procedure and diagnosis codes
https://www.forwardhealth.wi.gov/WIPortal/
         A. Click Online Handbook
         B. Choose I Accept radio button and Submit Agreement
         C. For user type, select Provider
         D. For program, select BadgerCare Plus and Medicaid
         E. For service area, select Vision
         F. Click Advanced Search
         G. Enter appropriate topic number and click Search

Cataract Surgery
Security Health Plan covers the insertion of the standard intraocular lenses during cataract surgery; there is no coverage for premier or vision correcting intraocular lenses. Claims related to cataract surgery should be submitted to Security Health Plan.

Please see ForwardHealth Topic 2265 for information related to appropriate billing for cataract surgery. https://www.forwardhealth.wi.gov/WIPortal/
         A. Click Online Handbook
         B. Choose I Accept radio button and Submit Agreement
         C. For user type, select Provider
         D. For program, select BadgerCare Plus and Medicaid
         E. For service area, select Vision
         F. Click Advanced Search
         G. Enter appropriate topic number and click Search

Non-covered Services:
The following vision care services and items are not covered:

  • Anti-glare coating
  • Spare eyeglasses (does not include replacement glasses that are lost or stolen)
  • Sunglasses
  • Services provided solely for convenience or cosmetic reasons, including, but not limited to:
    • Gradient focus
    • Custom prosthesis
    • Fashion or cosmetic items
    • Engraved lenses
    • Anti-scratch coating
  • Frames and lenses purchased through a vendor other than Classic Optical

Prior Authorization
Some vision services may require prior authorization through Security Health Plan. Please review the BadgerCare section of the “Contact Lenses and Other Eyewear” medical policy on the Security Health Plan Medical Policies page.

  • Prior authorization is required for eyeglasses beyond the limit of two with the same prescription per member per 12-month period.
  • Prior authorization is required for all non-contracted eyeglasses and eyeglass components.

Submitting prior authorization

  • To submit prior authorization to Security Health Plan, please complete both the ForwardHealth Prior Authorization/Vision Services Form (PA/VA) and a Prior Authorization Request Form (PA/RF) found here.
  • You can submit completed prior authorizations to: