Payers Frequently Asked Questions
Who is illuma Care Connections?
illuma Care Connections is a technology enabled services company that supports independent health care providers in their efforts to maintain their independence and thrive in the changing health care environment. illuma Care Connections helps formalize organic referral networks with a cloud-based technology platform, positioning these eyecare networks for patient population management. illuma Care Connections works with health plans to drive quality patient care, and brings these Health Plan partners and the eyecare networks together. Patients win, Health Plans win, and the Eye Care doctors win. illuma Care Connections was originally conceived within the American Optometrist Association as a way to support Optometrists in their transition into medical practice as a response to health care reform.
What does it mean to ‘build the medical side of a practice’?
By working with Health Plan partners to conduct quality programs for patients with chronic disease, illuma Care Connections helps coordinate care for these patients with eyecare network partners, bringing more medical eyecare to the Optometric and Ophthalmic communities.
What does illuma Care Connections do for me?
As an independent provider, illuma Care Connections supports your technology needs to ensure compliance with quality (PQRS/MARCA) programs, and works with health plans to schedule and see non-compliant patients who are in need of eyecare services.
How will patients find out about my practice and get scheduled?
illuma Care Connections staffs a full time patient contact center that will be conducting patient outreach to patients that need eyecare services. Once the patient is engaged, illuma Care Connections will schedule the patient with the practice that is most geographically convenient if they currently do not have a relationship with an eyecare provider.
How do you know if the patient has a relationship with another provider?
During the patient outreach process, our approved call experts ask the patient immediately if they currently have an eyecare provider. If so, illuma Care Connections will schedule the patient with that provider. If not, illuma Care Connections will allow the patient to choose the location most convenient to them among the panel of credentialed providers.
Will the vision plan be billed for this visit as part of the patient’s vision plan benefits?
No. This is a medical benefit and you will file claims with the medical plan.
What is the reimbursement?
You will receive the same reimbursement for services that you currently do today from the health plan. illuma Care Connections does not negotiate fee schedules.
What if I don’t see many patients from this program?
While there are no guarantees as to where the patients choose the location for their eye exam, if you are not satisfied with the program or the platform, you can opt out at any time.
What type of insurance does this quality program require for patients to be eligible?
illuma Care Connections works with multiple types of insured lives. The type of insurance will be transmitted during the scheduling process.
What is the financial burden on the patient for the recommended office visit?
It depends on the plan type. Because this is considered a preventative visit, for most Medicare patients there is not a co-pay.
Should we use the patient’s vision insurance for their refraction?
Because you are the doctor, and the patient is in your care, this is up to your discretion. We stand by what is best for the patient.
What if the requested time slot is already taken on the doctor’s schedule?
Once the request comes to your practice from the call center, you can work with the patient directly to schedule an acceptable time. If you absolutely cannot accommodate the patient, the request email will include the call center’s contact information and you can reach out to them to reschedule the patient at another practice.
Can we schedule other members of the family for eye exams?
Yes. You can ask the patient if they would like family members to be seen at your practice and work with them to understand the financial impact to them for those appointments.
What extra work if any will my staff need to take on?
Since the staff is already working to schedule referred patients, this should not create any extra work. The practices only responsibility will be to return clinical findings to our call center via CCDA or web form. This is probably part of current referral process and may just be a new and simplified workflow. illuma Care Connections will take care of all the work for you once we get those findings.
Want to Learn More?
Contact us today. Someone from our team can help you learn more about our quality programs, HEDIS improvements and risk adjustments.