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Posts Tagged Optometry Claims

Optometry Claims: Why You Should Use Vision Billing Software

File Folder Labeled as Claims.At Apex EDI, our goal is to help you create a better workflow within your clinic and simplify the billing process, so you can focus on patient care. The  has always been a source of frustration for office staff. Billing and coding errors can also be devastating to your practice.

An integrated software system means that vision claims can be transmitted directly from your system. This eliminates a tedious responsibility of entering patient data into more than one system or faxing information to other companies. Ultimately it saves staff a significant amount of time and energy. It also saves paper and money.

Any time information is re-entered, copied, scanned, or faxed it increases the potential for human error. Misspelled patient names, unreadable information, or incorrect billing codes can result in denied claims. A software, like Apex EDI, eliminates this risk. When insurance companies receive error free claims, this means you are reimbursed faster every time for every patient. It allows the front office staff to focus their attention on greeting patients with care.


Our integrated system also allows you to easily attach patient documentation such as progress notes. There’s no need to search for and organize this information when submitting vision claims. It’s literally at your fingertips. It also gives you the ability to easily view reports to help manage your practice.

You’ll be able to access financial data such as revenue per visit, patient cancellations, and accounts receivable. This powerful information allows your team to reach higher levels of productivity.

Contact Apex EDI to learn more and request a free demonstration of our software today.

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Optometry Claims: A Typical Visit to an Optometrist – What Your Claim Will Pay For

Even if you don’t need eyeglasses, it’s about time for a routine visit to an Optometrist. Our eyes play a very important role in our daily lives and a checkup can help prevent vision problems before they occur. If you’ve never had a vision exam, here’s what you can expect.


First, your doctor will ask you to read letters of various sizes from a chart to test your close and long distance sight. You will also be tested for glaucoma with a device called a tonometer that blows a puff of air into your eye. Depending on your age and health, you may also be tested for your side or peripheral vision, 3D, and color vision.

Medicated eye drops may be used to make your pupils larger. This procedure allows the optometrist to get a clear view of the inside of your eyes to detect cataracts, muscle degeneration, and diseases that can impair your sight. It may be helpful to bring a pair of sunglasses along because your eyes may be sensitive to light for a few hours afterwards. Some practices provide these for you, but it is smart to bring your own just in case!

If you do wear eyeglasses or contacts, bring them along for the visit. It’s essential to check your vision regularly because it’s quite normal for our sight to change as we age. You will also want to bring information about your medical history and any prescriptions.

 an eye

Most medical insurance policies don’t cover routine eye exams, unless there is a diagnosis. Vision plans cover routine eye wellness exams. At Apex EDI, we’ll make it easy for you to pay for your exam. We’re aware of the specific billing differences between medical and vision claims. It’s important to have a plan of action that will meet your specific needs, utilize all of your benefits and protect the health of your eyes.   

Contact us today to find out more about Apex EDI and how we can help you and your practice.

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Claims Processing: Optometry vs. Ophthalmology

Trusting a doctor with eye care is an important health care decision. The type of eye doctor a patient uses is largely a matter of personal preference if the eyes are healthy and don’t require specialized medical or surgical treatment. There are two types of eye doctors: optometrists and ophthalmologists. Both perform routine eye exams and are trained to detect, diagnose and manage eye diseases that require medical and non-medical treatment. Apex EDI handles both Optometry and Ophthalmology claims.

an eye

An optometrist is an eye doctor who has earned the Doctor of Optometry (OD) degree. Optometrists examine eyes for both vision and health problems, and correct refractive errors by prescribing eyeglasses and contact lenses. Optometrists in the United States are also licensed to prescribe medications to treat certain eye problems and diseases. The scope of medical care that can be provided by optometrists is determined by state law.


An ophthalmologist is a medical doctor (MD) or an osteopathic doctor (DO) who specializes in eye and vision care. Ophthalmologists are trained to perform eye exams, diagnose and treat disease, prescribe medications and perform eye surgery. They also write prescriptions for eyeglasses and contact lenses. It is important to seek care from an eye doctor highly trained if you already have a medical eye problem such as glaucoma, macular degeneration or cataracts. In many cases, this means that medical or surgical eye care by a specially trained ophthalmologist is in order.

Another factor in the patient’s selection of an eye doctor is determining if he or she is an authorized provider under the vision or medical insurance plan. Most optometrists and ophthalmologists accept Medicare for older patients. However, while Medicare covers your visits to an eye doctor for medically necessary eye care, it does not cover routine eye exams. Prior to the submission of a claim, it’s helpful to verify coverage and out-of-pocket expenses for the exam.

Articles with this disclaimer may not represent the beliefs or core values of Apex EDI. The above is simply a summary taken from the industry’s general community to help readers stay up-to-date on what people are talking about.


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Claims Processing: Medical Claims vs. Vision Care Claims

When handling claims regarding eye health, there are a few things to be aware of. For example, there are specific differences between what can be billed to a vision plan and what should be billed through medical insurance. Let’s discuss the difference between the two claims, and why eye care professionals need to know the difference.

girl with glasses

The Difference

Vision plans cover routine wellness exams for eye health. This means examinations for near- or farsightedness, astigmatism, and corrective lenses. Medical eye care on the other hand is for the treatment of specific medical conditions related to the eye, such as pink eye, cataracts, double vision, etc.

Why It Matters

As we discussed above, vision plans cover annual exams for eye health. When an exam reveals a condition such as pink eye, cataracts, glaucoma, dry eye, or another condition, the diagnosis and treatment is billed through the medical eye care insurance. A medical eye condition typically requires a more intensive treatment plan than what is covered through a run of the mill vision plan, which is why medical insurance typically steps in.

As the provider, you will want to ensure that you are billing the correct insurance in order to receive the fees you are due. Many eye care professionals bill the vision plan first, and then reach out to the medical plan if any fees have yet to be covered. It is also important to discuss the plan of action with the patient so that they are aware of how the services will be billed to their insurance and that they are aware of any fees that may accrue due to their specific plans.

The Solution

In order to ensure the best possible care for your patients and management of your optometry practice, implementation of a clearinghouse for claims billing is recommended. A clearinghouse verifies vision and medical claims before they can be sent to the payer for final submission.

Apex EDI is a user friendly and fully integratable clearinghouse that works to get you paid faster. For more information about how Apex EDI can be used to benefit your optometry practice, click here.

Articles with this disclaimer may not represent the beliefs or core values of Apex EDI. The following is simply a summary taken from the industry’s general community to help readers stay up-to-date on what people are talking about. 

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News & Events: Apex EDI (Electronic Claims Processing) Integrates with My Vision Express Software

My Vision Express logo

(Salt Lake City, UT) March 28, 2014 — Apex EDI, is proud to announce their integration with My Vision Express (MVE) Electronic Health Records and Practice Management Software for Eye Care Professionals (ECPs), for electronic claims processing. More details will be released in the official press release March 28th at the Vision Expo East International Ophthalmic event.

This powerful integration allows MVE users to “click” and send claims electronically to Apex EDI, directly from their software. The interface also features an insurance portal to verify patients’ eligibility at the time of service verify claims status, and view and fix claim errors. Additionally, Apex and MVE are focused on facilitating ECPs efforts to meet the requirements of the ICD10 and EMR/meaningful use requirements. These new features will assist ECPs to reduce their accounts receivable and streamline claims management, enabling them to focus on providing patient care.

“We are excited to provide Apex EDI insurance clearinghouse services with our software,” said Vipul Katyal, President, My Vision Express. “Together we are providing better solutions that provide exceptional value to the eye care industry!”

“My Vision Express software continues to demonstrate the power of innovative software. We are excited to offer our services as part of their integrated solution to optometry providers,” said Sheldon Miner, Chief Executive Officer of Apex EDI.


Apex EDI is a leading healthcare claims clearinghouse for medical and optometric professionals. Apex EDI serves thousands of physicians, optometrists, and other medical providers nationwide with its Apex OneTouch® solution. The OneTouch® solution is a Web-based electronic claims reimbursement system that increases productivity and profitability while facilitating fast payment of insurance claims and providing additional reporting and analysis. For more information about APEX EDI, visit: (800 840-9152)

About My Vision Express

My Vision Express was designed exclusively for optometrists, ophthalmologist, and opticians who want to boost the efficiency and growth of their practices. My Vision Express features a comprehensive EHR, innovative POS, and many powerful inventory, business, marketing, and staff management tools and attest for Meaningful Use Stages 1 and 2.

Multiple licensing options are available with My Vision Express, from single computer users to multiple computer users across multiple locations, so there is a solution for every type of practice. My Vision Express is easily accessible on the devices you currently own – Windows, Macs, iPhone, iPad, Android, and Kindle – enabling you to manage your practice from anywhere and is available as both Cloud and in-office server solutions.

My Vision Express offers a free 30-day trial of the software. Contact 1-877-882-7455 or visit for more information.

My Vision Express
3050 Universal Blvd, Suite 120 – Weston, FL 33331
1.877.882.7455 –

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