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45.3 Provider Responsibilities
Suppliers of eyewear must comply with all Medicaid provider responsibilities and adhere to the following guidelines:
• Do not delay the ordering of eyewear or the dispensing of eyeglasses to the client while payment is pending from TMHP.
•Deliver the eyewear in a reasonable amount of time (usually two or three weeks from the date the order is placed by the client).
•Obtain the required eligibility information from the client's Medicaid Identification Form (Form H3087).
•Refer to the Eyeglasses column of the Medicaid Identification Form (Form H3087) to determine whether eyeglasses have been dispensed at Medicaid's expense within the last 24 months. Providers are advised to ask clients if they have recently received vision care services that may not appear on the Medicaid Identification Form (Form H3087) because of the monthly lag in updating form information.
•Update the Eyeglasses column of the Medicaid Identification Form (Form H3087) to indicate that eyewear was dispensed. Initial, date, and mark the form to indicate that the service was performed. Temporary cataract lenses or glasses are payable during the four-month convalescent period even if the Medicaid Identification Form (Form H3087) does not have a check mark (3) under the Eyeglasses column. However, the Medicaid Identification Form (Form H3087) must not have a check mark under the Eyeglasses column if nonprosthetic eyeglasses are to be obtained for use in conjunction with cataract contact lenses.
•Have the client sign and date the Vision Care Eyeglass Patient Certification Form and retain it in the providers' records if the client selects eyewear that is not covered or eyewear is lost or destroyed.
•Have the client, parents, or guardian sign and date the Vision Care Eyeglass Patient Certification Form and retain in their records.
•Do not charge a Medicaid client more than a patient not enrolled in Medicaid for noncovered services (e.g., tints, oversized lenses, or frames).
•Keep invoices on file for a minimum of five years.
•Submit claims using the date eyeglasses were ordered as the date of service (DOS) (the start of the 95-day filing period), not the date the eyewear was dispensed.
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