FAQ PIA Optical Online Web Site
#1: What are the requirements for getting a PIA account?
PIA account requirements are:
1. Applicant must be enrolled as a Medi-Cal Fee-for-Service provider with the Department of Health Care Services or as a Medi-Cal managed care plan provider. For applicants who are only managed care providers, you must also be enrolled as an Ordering/Referring/Prescribing (ORP) provider. Medicare providers are exempt from enrollment as Medi-Cal ORP.
2. Business address must match the professional licensing board records.
3. Business Address must match Medi-Cal and/or Medi-Cal managed care vision plan provider records (i.e., Medi-Cal Provider Enrollment, Vision Service Plan). The “business address” must be a physical location where services, goods, supplies or merchandise are provided directly or indirectly to a Medi-Cal recipient. A post office box or commercial box is not a business address.
PIA account requests are submitted electronically to the DHCS Vision Services Branch for review via the PIA Optical On-Line System, https://optical.pia.ca.gov/pool/
Accounts are not transferable.
*Forms and applications are available through Provider Enrollment Division found through the Medi-Cal website at www.medi-cal.ca.gov or contact the Telephone Service Center at (800) 541-5555.
#2: How do I update my address information on the PIA Optical website?
Log into the CalPIA Optical Online website at https: //optical.pia.ca.gov/pool.
Select the “Maintain Profile” menu tab and select the account management option of “Address Change”, update the address and press “Submit Request.” You will be notified by e-mail if approved.
New address must match the current professional license, Medi-Cal and vision plan provider records (see requirements for #1). Temporary status may be granted subject to DHCS review and approval.
As a reminder, providers are responsible to notify Medi-Cal Provider Enrollment of address changes.
#3: When we entered the prescription for a patient, we get the following message: “parameter(s) requested exceeded the range of what can be fabricated at PIA…” What do we do?
Since the order is unable to be made at PIA, it must be obtained through a private lab of your choice by seeking prior authorization for the service and subsequent reimbursement.
If the patient is enrolled in Managed Care Vision Plan, please obtain authorization by the plan directly, such as VSP.
If the patient has Fee-for-Service, “straight”, Medi-Cal, please submit an Electronic Treatment Authorization Request (eTAR) to Medi-Cal Vision Services Branch.
Tips for submitting a Vision eTAR on the Medi-Cal website, www.medi-cal.ca.gov:
· Select/Click on the <Transactions tab>, next click on <e-TAR>;
· Then select <Medical Services> to access the eTAR menu;
· Click on ->> <Create a New TAR>;
· Enter provider information. Fields designated with an asterisk (*) are required;
· Enter patient information when requested;
· Next, under <Other Services>, please select a Vision Service Category, (i.e., Vision – Other Eye Appliances)
· Enter required information, including service code(s) that require a TAR, ICD-10 code. Medical justification for the service is entered in the Enter Misc. TAR information field/box;
· Click on TAR summary to review the eTAR before submission;
Please select an Attachment Submission Option then click
· After the TAR is submitted, a TAR number will be generated;
· Please wait for DHCS review;
· If approved, obtain lenses through a private lab of your choice (not PIA) and bill Medi-Cal with invoice and TAR Control Number, TCN (enter on claim form as “prior authorization number”).
For a further assistance, please contact the Medi-Cal telephone call center at (800) 541-5555.
#4: The patient’s eyeglass order was rejected because of Other Health Coverage (OHC). What does this mean?
The Medi-Cal eligibility system indicates that the patient has OHC with Vision Benefits. The provider should contact that OHC plan for services since Medi-Cal is not involved. If the patient denies having OHC, please refer the patient to his/her county social services for resolution.
#5: The patient’s eyeglass order was rejected because of remaining Share of Cost (SOC). What does this mean?
Since this patient has remaining SOC/Spend down, he/she is not eligible for Medi-Cal/CalPIA services. Beneficiary’s monthly SOC/Spend down dollar amount must be cleared before he/she is qualified for Medi-Cal. Please note if the SOC is used toward the patient’s eyeglass lenses, the order must go to a private laboratory, not PIA, for fabrication.
#6: What is the criteria for ordering polycarbonate lenses for patients 18 yrs. and older?
Must have one of the following visual impairment in one or both eyes:
· best corrected visual acuity of 20/60 or worse
· restricted visual field of ten degrees or less
Please note polycarbonate lens orders must meet Medi-Cal minimum prescription requirements. For example, plano protective lenses are not covered.
#7: Who to contact regarding Medi-Cal billing questions?
For patients covered under managed care vision plans, please contact the plans (e.g., VSP) directly. For Medi-Cal Fee-For-Service (FFS), billing information can be found in the Medi-Cal Vision Care Provider Manual available at www.medi-cal.ca.gov or call the Telephone Service Center (TSC) at (800) 541-5555.
#8: Are there limits to the number of eyeglasses covered?
Yes. Eyeglasses are covered once every 24 months. There are limitations; state law says orders or replacements are subject to utilization controls set by the Department of Health Care Services.
#9: Are beneficiaries with aid code coverage that is “restricted to pregnancy and emergency services” eligible for eyeglasses?
No. Eyeglasses are not considered pregnancy or emergency services.
#10: Who is eligible for CalPIA eyeglasses lens services?
Medi-Cal beneficiaries under 21 years of age with full benefits eligibility. Exceptions to this are Medi-Cal beneficiaries 21 years of age and older receiving long-term care in a skilled nursing facility or intermediate care facility
#11: Why are orders from San Mateo, San Luis Obispo, and Santa Barbara Counties not allowed?
These counties do not use CalPIA services. Please contact the Manage Care Plans directly for assistance. If your patient has fee-for-service benefits from these counties, please submit a Treatment Authorization Request (TAR). See answer to question #3 for TAR procedure.
#12: How to get shipping labels for sending orders to the lab?
You can print your own labels.
· Go to website, http://dst.unitycourier.com
· If you are not a registered user, please contact Unity Courier Service's Customer Care Dept. at (800) 992-8890 and select option #2
· Login using your assigned customer ID e-mail and password
· On the main screen, select <ship package> from the quick links.
· Click on the <Company> drop down box and enter "PIA"
· Select your Primary Lab
· Select F12
· Select Print
#13: How to make changes to my PIA Optical Online Account information?
Please submit requests online by selecting “Maintain Profile” from the option menu. To prevent fraud, all change requests are subject to review and approval by the Department of Health Care Services/Vision Services Branch. When necessary, please follow procedures as instructed by PIA Optical Staff for verification. For further assistance, please contact customer service.
#14: Is there a new vision plan for some patients with HealthNet Medi-Cal in SoCal Counties?
Yes, as of December 1, 2016, HealthNet Medi-Cal plan in some Southern California Counties have a new Vision Plan partner, Envolve Vision. These HealthNet Medi-Cal patients are no longer covered through Vision Service Plan (VSP). Calls or questions regarding Eligibility & Benefits, Billing, Claim Status or Find a Provider should be directed to Envolve Customer Relations at (800) 334-3937 or visit https://visionbenefits.envolvehealth.com/index.html
PIA lab services remain the same.