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Information About Primary Plus
Welcome | Primary Plus Highlights
| Eyecare Benefit Designs | Credentialing
Infrastructure | Quality Improvement Program | Medical/Surgical Eyecare Services
Commonly Asked Questions
Welcome
The rate of change in the delivery of health care will continue at the current hectic pace for some time. Governmental entities are allowing managed care programs to play a significant role in reforming the health care system.
CompBenefits has responded by developing a high quality, cost-effective, and customer friendly managed eyecare program called Primary Plus.
As one of the Florida's largest providers of eyecare services, Primary Plus is
unequaled by any other eyecare provider. CompBenefits has more than 25 years
experience of successfully operating plans in Florida and currently provides
benefits to more than 2.1 million Floridians. This experience has proven that
the maintenance of uncompromising quality standards and cost reduction methods
has generated extraordinary satisfaction with our plan members and managed care
organizations.
The Primary Plus program is a statewide ophthalmologic/optometric physician network created to provide the highest quality medical, surgical, and optical eyecare services to our patients. The Primary Plus program encourages preventive measures through early detection of health problems and provides total integrated eyecare services for patients including surgical, post-operative, urgent, and emergency care. Treatment is available at several levels: primary, secondary, tertiary, and advanced sub-specialty care.
CompBenefits is committed to offering a full continuum of eyecare services which are coordinated through the primary eyecare provider. Our Board's Quality Improvement Program ensures both patient satisfaction and high professional standards consistent with clinical practice guidelines. These activities and others demonstrate
our commitment to being a leader in the managed eyecare industry.
Primary Plus Highlights
The goal of managed care is to deliver quality, cost-effective care.
Primary Plus achieves this goal through our Board-Certified Provider Network, structured Quality Improvement Program, and a solid infrastructure for claims processing and Customer Care. Each of these components contribute to making the Primary Plus integrated eyecare delivery system the plan of choice for managed care members across the state of Florida.
Primary Plus prepaid eyecare delivery system offers health plans the assurance
of cost control, quality, board-certified providers, and a wealth of experience in the delivery of eyecare.
Eyecare Benefit Designs
Primary Plus' board-certified network of optometric physicians provide plan members with quality eyecare services.
Primary Plus benefits are tailored to match the plans' specific benefit designs. In most cases, we can assist a plan in reducing the cost of their routine vision benefit. A kit of stylish, yet low-priced eyewear is available in each of our optometry offices. These eyeglasses can easily meet the health plan requirements for a valuable vision benefit. Primary Plus can provide a variety of allowance-type benefits in addition to our Select Eyewear.
Credentialing
Primary Plus credentials contracted providers with primary source
verification of licensure, malpractice insurance, education and
certification by the American Board of Ophthalmology or Florida State Board
of Optometry, among other requirements.
Providers are recredentialed every three years. Our credentialing files are available to our partner plans, allowing them to utilize our credentialing process to fulfill their NCQA standard requirements.
Infrastructure
Primary Plus has the benefit of being under the umbrella of
CompBenefits, Inc. which also administers VisionCare Plan for the State of Florida.
VisionCare Plan has been serving the needs of hundreds of thousands of Floridians each year for over 25 years.
we have the experience and the infrastructure in place to provide a total delivery system. Primary Plus utilizes the talents and knowledge gained through years of experience in administering eyecare claims.
Our full staff of customer care agents are well qualified and experienced in
handling eyecare claims. They will assist members and providers in ensuring a
smooth uncomplicated administrative process.
Provider Communication
Primary Plus maintains extensive communication with doctors and their staff through educational seminars, provider manuals, provider bulletins, and updates.
Managed eyecare providers are also encouraged to offer suggestions through several avenues at the local and state level to improve the eyecare delivery system. Primary Plus promotes active involvement in meeting the goals of the overall managed care program by physician participation in the Utilization Review Committee and Quality Improvement Committee.
Quality Improvement Program
Primary Plus is committed to the principles of quality that ensure efficient and effective delivery of eyecare to patients.
We continually strive to improve the clinical care provided to patients through
our Primary Plus Providers. Primary Plus continually measures and improves
eye care services through the following processes:
Utilization Management
To ensure appropriateness of services, Primary Plus' Utilization Managed Program monitors appropriate utilization for all services, referrals, and admissions. Cases indicating potential for problems are referred to the Quality Improvement Panel for further investigation.
Clinical Guidelines and Protocols
Primary Plus uses the Clinical Practice Guidelines for the American Optometric Association in conjunction with the Preferred Practice Patterns approved by the American Academy of Ophthalmology as an integral part of the managed eyecare program. These guidelines provide assistance to doctors in the co-management of routine and medical eyecare services.
Patient and Provider Grievance Resolution
Primary Plus has established standards for the resolution of grievances in a timely and efficient manner through the Quality Improvement Program. Patients and providers may address concerns to make a complaint regarding claim payment, denial of services or any aspect of their care by filing a written notice with Primary Plus. The Hearing and Appeal Process will cause an investigation and the appropriate resolution is implemented.
Medical/Surgical Eyecare Services
Primary Plus controls patient access through a network of primary eyecare providers. These primary eyecare providers are Board-Certified Optometric Physicians who have completed extensive training in the diagnosis and treatment of medical eye problems and vision care services.
Primary Plus has the flexibility to provide alternative delivery system options while maintaining the commitment to render quality services cost-effectively. The preferred co-management model accomplishes the dual goals of exceptional service and cost control by offering a full continuum of eyecare services accessed through a primary eyecare provider.
Accessing care is as easy as telephoning the provider's office for an appointment. The primary eyecare provider delivers medical eyecare within the scope of licensed authority and coordinates other necessary treatment. Care is available for medically necessary surgical procedures and advanced medical treatment of eye diseases through referral to our network's Board-Certified Ophthalmology panel. These physicians must be certified by the American Board of Ophthalmology and provide advanced surgical eyecare upon referral. Throughout the Primary Plus Network treatment is provided at the most appropriate setting.
Following any advanced medical or surgical treatment, the patient returns to the selected optometric physician. This primary eyecare provider will resume overall patient eyecare management. The primary eyecare provider will keep the patient's primary care physician informed of the patient's condition and any proposed treatment plan. The primary care physician, primary eyecare provider, and the ophthalmic specialist work as a team to manage and provide quality, cost-effective care.
Commonly Asked Questions
Q: How will ophthalmology and optometry work together in the face of expanding managed care?
A: Managed Care focuses on the delivery of quality cost-effective care. Both Optometry and Ophthalmology have an important role in the delivery of eyecare services. Optometric physicians have become recognized as effective providers in the overall management of ocular conditions. Ophthalmology co-manages with optometry by providing advanced medical treatment and surgical care. Managed care focuses on the appropriate level of care being delivered by ophthalmologists and optometrists. These providers work well together in delivering optimum care through a co-management structure. Primary Plus works closely with the providers through provider education, utilization management and quality assurance.
Q: What is the difference between VisionCare Plan and Primary Plus?
A: CompBenefits offers both VisionCare Plan and Primary Plus. VisionCare Plan works with employer groups statewide to provide a vision-only eyecare program. Primary Plus focuses on the total eyecare concept, providing delivery of services ranging from vision exams and eyeglasses through the most complex surgical and laser procedures. Primary Plus provides eyecare services to Managed Care Organizations, Indemnity Insurance Plans and large self-funded employer groups.
Q: Why would it benefit a Managed Care Organization to work with Primary Plus rather than their local panel of providers?
A: Primary Plus' administrative and financial resources strongly support the development of the managed eyecare delivery system for physicians. We are prepared, both conceptionally and financially to assume the risk for the delivery of eyecare services through our managed eyecare providers. Our provider reimbursement method is structured to share the financial risk with contracted providers, offering a guaranteed level of reimbursement while promoting controlled utilization.
Q: How does Primary Plus negotiate managed care contracts?
A: Primary Plus considers demographic and utilization data when underwriting a prospective managed care group contract. A health plan's past utilization is carefully studied along with other available statistical data pertaining to the proposed patient population. The Primary Plus objective is to create a win-win situation for patients, providers and payers through the delivery of quality, cost-effective services provided by physicians working together to effectively co-manage eyecare.
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