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Program Management

Tailoring vision benefit management to meet our clients’ individual goals.

Ocular

Overview

Ocular Benefits offers comprehensive program management customized to meet each individual client’s business requirements. We integrate cost containment, utilization management, fraud detection, regulatory compliance, provider network management and more with automation driven by one of the world’s most innovative software platforms in order to help clients manage the cost of vision care diligently and effectively. With the expertise and flexibility to tailor our services to your goals, we will serve as a strong partner to your organization. 

Cost Containment

Ocular Benefits supports ongoing cost containment for clients through regular, in-depth review of their benefit costs.  We conduct monthly audits of claims processing to ensure accuracy of all payments, and correct management of coordination of benefits. Through utilization management, we examine appropriateness of care, and can track trends which may indicate potential fraudulent or abusive practices.  With our extensive expertise, and data management capabilities available through the Enterprise System, Ocular Benefits is well-positioned to maintain a close watch over our clients’ benefit spend for vision care.

Utilization Management

As part of our comprehensive vision benefit management, Ocular Benefits offers integrated utilization management to help clients control cost. Our goals are to promote members’ eye health and to ensure that all vision care services are necessary, appropriate and delivered in the most cost-effective manner.  With the Enterprise System, we can enable service authorizations based on business rules configured to each client’s business requirements and reimbursement strategies.  Ocular Benefits complies with all recognized utilization management and review standards as they apply to vision care through federal and state regulations.

Fraud, Waste & Abuse Detection

With the ongoing increase in healthcare fraud, fraud prevention has become critical in benefit management. Ocular Benefits’ highly experienced team works to expose potential fraudulent services and abusive billing practices using sophisticated technology. The Enterprise System, our proprietary software platform, is designed to detect unwarranted vision care claims and fraudulent billing. We’ve also built fraud prevention into our workflow processes. Ocular Benefits investigates cases of suspected fraud and abuse through an enhanced review process. Our aim is to reduce costs for our clients and ensure benefit resources are used appropriately for their members.

Regulatory Compliance

With our depth of experience and agile software platform, Ocular Benefits is known as the “safe choice” in vision benefit management in terms of compliance with government regulation. Our compliance team stays knowledgeable and informed of state and federal regulations pertaining to vision care and coordination of benefits. We leverage innovative technology developed by our sister company, Wonderbox Technologies, which proactively upgrades its software platform to keep pace with future requirements and expectations. Our track record demonstrates we have consistently met new state and regulatory requirements well in advance of their effective dates, including compliance with HIPAA 5010 transaction sets and ICD-10 coding.

Grievances & Appeals

Provider satisfaction is essential to Ocular Benefits’ high level of quality in vision benefit management. To maintain high levels of satisfaction, our appeals team responds to complaints, grievances and appeals quickly and thoroughly, delivering a speedy resolution. We ensure providers are treated with dignity and respect at all levels of the process. To assist clients in their efforts to address any ongoing service issues, we proactively track and report complaint and grievance trends to our clients.

Member Outreach

Ocular Benefits’ member outreach is designed to help members take full advantage of the wellness care provided by their vision benefit program. We employ several channels of communication, including telephone, email and direct mail, to ensure members stay on schedule with their wellness visits. Our outreach communication is HIPAA-compliant, and can be private-labelled at our clients’ request in order to provide a seamless experience for members. Member outreach is just one more strategy Ocular Benefits leverages to manage our clients’ vision benefit programs for peak efficiency.

Ocular Benefits, LLC

W140 N8981 Lilly Rd.
Menomonee Falls, WI 53051
info@skygenusa.com

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