VSP: Strategies for Enrolling with the Nation’s Largest Vision Payer

The popular New Year’s resolution to exercise more and eat better often comes with a health-related to do list. Tasks like gym sessions are added to needs like annual check-ups and visits to specialists like the eye doctor. The New Year is a popular time to visit an eye care specialist for an exam, and with allowances being replenished at the beginning of the year, many patients opt to purchase glasses or a large supply of contacts. In many cities, demand for popular optometrists means appointments are sometimes hard to come by.

As is true across most categories, patients rarely opt to see an eye doctor that is out of network if they can avoid it. That’s why gaining and maintaining credentials is critical to keeping patient volume high. And when a patient walks through the door, a provider wants to ensure they are being paid in-network rates for the subsequent services. Additionally, it may be difficult for eye care professionals to be retained within an insurance network without being credentialed.

The majority of healthcare plans utilize VSP for vision coverage, so much so that 1 in 4 Americans is covered under VSP, according to The Centers for Medicare and Medicaid. With so many patients using the program, it’s critical to have VSP credentials in place.

In order to become a VSP provider, you must:

1. Gain an optometry license
2. Sign up for liability insurance
3. Obtain an NPI number
4. Register with CAQH
5. Show proof of state licensure, malpractice insurance and all relative credentials
6. Share necessary board certifications

To say that credentialing can be a daunting task may be an understatement. There are robust applications and various deadlines that cannot be missed. One misstep on an application can delay approvals by weeks or even months. A lapse could interrupt your cash flow and hurt the financial outlook for the entire year. In fact, 54 percent of optometrists reported an increase in credentialing-related denials. Thankfully these are easily avoidable. Taking a proactive approach and having everything in place helps avoid denials, which maximizes returns and keeps cash flow high.

Even more, there is a potential long-standing impact if credentialing collapses. Patient satisfaction could suffer if providers are no longer covered under plans or lapses in coverage affect appointments. With many vision patients only seeing a provider once a year for a check-up or to order glasses, it’s important to make the experience a good one.

The key to growing your practice truly starts with credentialing. Because of the complexity of the process, outsourcing to credentialing experts is often the right answer for many practitioners. With 25,000+ vision providers, TriZetto Provider Solutions can provide expert experience for eye care providers. Let us help you get credentialed in 2022. Visit our Credentialing page to get started.