Optical - Eyewear Order Guidelines
Effective Date: January 1, 2012, Per Exhibit C of the Inc. BadgerCare Affiliated Provider Subcontract:
Security Health Plan of Wisconsin, Inc. (“Plan”) has contracted with Classic Laboratories, Inc. (“Classic Optical”) to supply eyewear for recipients enrolled in Plan’s BadgerCare/Medicaid Managed Care Program. Classic Optical will provide the frames and lenses for Plan’s BadgerCare/Medicaid recipients.
Plan’s affiliated Optometrists/Ophthalmologists are required to use Classic Optical when ordering frames and lenses for a Plan BadgerCare/Medicaid recipient. Any other eyewear will not be covered under the recipient’s BadgerCare/Medicaid benefits.
Plan will provide coverage for BadgerCare/Medicaid recipients who select the Plan as their HMO and present a Forward Health card with current eligibility.
Plan will reimburse Optometrist or Optician at the current Medicaid fee for fitting and dispensing the glasses.
Classic Optical will follow the same guidelines as Medicaid Fee for Service.
To Place Prescription Orders:
Prescription orders can be placed 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.
Prescription orders can be faxed to: (888) 522-2022
- Prescription orders can be mailed to:
Classic Optical Laboratories, Inc.
P.O. Box 1341
Youngstown, OH 44501
Glasses will be shipped within 2 weeks under normal circumstances.
Contact Classic Optical Customer Services at: (888) 522-2020. Hours of operation are 7:30 am to 6 pm CST.
Process to Obtain Prior Authorization:
- Plan follows Forward Health protocol for coverage of glasses for BadgerCare Plus members.
- Covered vision procedures are identified by the CPT or HCPCS procedure codes and modifiers listed in the interactive maximum allowable fee schedules. Some services may require authorization. In these cases if the lenses have certain specifications like tint, bifocal, or polycarbonate that prove medically necessary, providers will need to request prior authorization from Plan prior to ordering any of these options. 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 or services provided solely for convenience or cosmetic reasons (i.e. fashion or cosmetic tints, anti-scratch coating, etc.).
- To submit a prior authorization request for vision services to Security Health Plan, providers need to use the Forward Health forms PA/RF (prior authorization request form), along with the PA/VA (prior authorization vision attachment) and any supporting clinical documentation.
- Providers can obtain these forms and the instructions to complete them from the Forward Health provider handbook.
- Providers must fax the request to Security Health Plan BadgerCare Plus Claims at 715-221-9937.