Explore the full range of solutions Helpware divisions provide:
Get every vision and medical claim to the right payer the first time, with accurate coding and timely submission that keeps payments moving and reduces costly rework. Partner with us and enjoy the benefits of our vision and optometry billing expertise.
Your billing team works inside your practice management system from day one, working to your fee schedule and payer rules so claims go out accurately without forcing your practice to rebuild its workflow.
We recruit, train, and manage billers who know both vision plan rules and Medicare, so you avoid the hassle of building the team yourself.
Your gain:
Lower fixed payroll, flexible coverage as patient volume changes, more budget for patient care and optical services.
We check frequency limits, modifiers, and plan allowances before submission and correct issues before they become rejections.
Your gain:
Faster payment cycles, fewer claims stuck in rejection queues, less time spent fixing billing errors.
We flag bundled test pairs, duplicate benefit-year claims, and exam-level mismatches for review before filing.
Your gain:
Fewer post-payment takebacks, a cleaner audit trail, less staff time spent handling records requests.
We review vision and medical claims every week against your billing standards and correct any issues we find before they become recurring problems.
Your gain:
Fewer avoidable denials, cleaner remittances, less rework coming back to your front desk.
We are fully compliant with all necessary data protection protocols and implement advanced security measures across our operations. This approach reduces compliance risks, simplifies audit processes, ensures transparency, and increases customer trust in highly regulated and sensitive environments.
We enforce strict access controls, ensuring security and confidentiality across on-site and remote teams to maintain the integrity of client data.
We collect only necessary personal data, retain it for defined periods, implement multilevel security, and provide full user control over it.
We safeguard protected health information through end-to-end encryption, secure access protocols, and real-time threat detection.
We secure payment data throughout processing and storage, continuously monitoring our systems to identify and address potential risks.
Our specialist billers verify benefits, code each encounter, and submit claims to the right payer with accurate, timely detail, helping your practice keep collections steady month to month.
We verify benefits and submit routine exams, frames, and lens orders to VSP, EyeMed, or Spectera.
We code and submit medical encounters to the right medical payer, from glaucoma follow-ups to diabetic eye exams.
We handle fitting fees, material allowances, and patient shares accurately on every contact lens order.
Our certified coders match each encounter to the right 920xx or 992xx code family and post charges daily.
We correct denied claims, prepare payer-specific appeal letters, and track each claim through resolution.
Our vision and optometry billing experts handle balance questions, payment plans, and refraction charges throughout every statement cycle.
Growing eyecare practices face different billing pressures as patient volume, locations, and payer requirements change. We build the team and workflows around your practice, so billing keeps pace as you grow.
Keeping billing consistent across multiple locations gets harder when each team follows its own processes. Our billing experts apply the same coding standards and review process across every clinic. You get consistent claim accuracy across locations.
Benefit-year resets can send vision plan volume surging faster than your billing team can handle it. Our dedicated billers absorb the extra work and submit claims against the right plan allowances. Submission timelines stay on track through the busiest weeks.
Out-of-network claims can get passed between customers, opticians, and payers without anyone owning the process. Our team prepares, submits, and follows each claim through to resolution. Customers get more predictable claim turnaround.
Billing capacity drops quickly when a certified eyecare coder is out and there is no one ready to cover the work. Our trained coders provide coverage across holidays, leave, and month-end. Charge lag stays steady even when your staffing changes.
Get ROI projection for current support needs.
-40% annually
/monthly costs with Helpware
vs
/internal team costs (approx)
Your requirements fall outside our standard parameters.
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-40% annually
/monthly costs with Helpware
vs
/internal team costs (approx)
Your requirements fall outside our standard parameters.
-40% annually
/monthly costs with Helpware
vs
/internal team costs (approx)
Your requirements fall outside our standard parameters.
Shared Team Leader
Shared L&D Specalist
Shared QA Specialist
Account Executive by default
Shared Ops Delivery Manager
Admin/Finance/Legal support for the agents by default
1-2 Dedicated Team Leaders
Shared L&D Specialist
Shared to 1 Dedicated QA Specialist
Shared Ops Manager
Account Executive by default
Admin/Finance/Legal support for the agents by default
Shared Real Time Analyst
2-5 Dedicated Team Leaders
0,5 to 1,5 Dedicated L&D Specialists
1-2 Dedicated QA Specialists
Up to half of a dedicated Ops Manager
Account Executive by default
Admin/Finance/Legal support for the agents by default
1 Dedicated Real Time Analyst
Ready to get a personalized estimate for your team?
Contact us for a personalized assessment tailored to your specific needs.
*These projections are estimates for informational purposes only and do not represent a formal offer. Contact us for a personalized quote.
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AI handles routine checks across the billing process, while our billers take care of the decisions that require experience. It verifies coverage, catches potential errors, and flags denial risks, while our team handles exceptions, appeals, payer follow-up, and patient questions.
Compares registration details with payer records and flags mismatches before we build the claim.
Checks vision and medical plan eligibility in parallel, returning both results faster than manual lookups.
Scores each claim for denial risk and routes high-risk claims to a senior coder before filing.
Replaces phone and portal follow-up with electronic transactions across the claim lifecycle.
Compare vision plan allowances with your contracted rates and flag underpayments before they become recurring losses.
Decide whether each visit belongs to the medical or vision plan and document the reasoning so claims reach the right payer.
Build appeal packets from chart notes, test results, and the payer policy that supports your case.
Explain refraction charges, plan allowances, and remaining balances clearly, without forcing patients through a script.
We review a month of remittances, map your payer mix, and set targets for clean claims, A/R days, and collections.
We select billers experienced in eyecare codes and vision plan portals, then complete HIPAA and background checks before day one.
We train the team on your fee schedule, chart templates, and check-in scripts, then review live encounters until accuracy holds.
We verify benefits, code encounters, file claims to both payer tracks, and work denials daily, with a weekly report on aging.
We group denials by reason and payer each quarter, fix the intake or coding step behind them, and track the impact on collections.
Eyecare billing works better when your team knows your payers, workflows, and standards inside out. We keep experienced people on your account and keep improving the operation as your needs change.
With Helpware CX, your patients get clear answers about charges, coverage, and balances from specialists who understand their billing, keeping conversations helpful and frustration low.
We retain experienced billers, so you keep the people who know your payers, workflows, and billing rules instead of retraining a new team.
Our global coverage gives you billing capacity across time zones, with backup coverage during holidays and employee absences and extra capacity when billing volume increases.
The majority of clients stay with us long term, enjoying a billing partner that adapts to their needs, improves the operation over time, and scales with their growth.
CSAT
ESAT
locations
years average length of client partnership
30+ industry awards recognize the quality of our work. You get accurate claims, steadier collections, and a billing operation that keeps improving as your practice grows.
Vision and optometry billing covers two separate payer tracks. Routine exams, frames, lenses, and contact lenses are billed to vision plans such as VSP or EyeMed, while medical eye conditions such as glaucoma and diabetic retinopathy are billed to medical insurance under the 920xx or 992xx code families.
No. Medicare doesn’t cover routine eye exams for eyeglasses or contact lenses, so patients generally pay for these non-covered services. Refraction, CPT 92015, is also outside Medicare coverage and must instead be billed to the vision plan or collected from the patient.
Yes, when the visit includes separate services covered by each plan. The medical plan can cover an exam when a medical condition drives the visit, while the vision plan can cover the refraction separately. That means two claims can be submitted to two payers for the same date of service when the chart documents both services.
Billing an encounter to the wrong payer is a common cause of eyecare denials, followed by frequency limits, missing plan authorization, and inaccurate intake data. The intake problem is significant: Experian Health found that 26% of providers trace at least one in ten denials back to information collected at check-in.
Aged accounts are worked in parallel with new claims during the transition. We split the backlog by payer and denial reason, then file corrected claims or appeals before timely filing windows close. Vision plan filing windows commonly run 90 to 180 days from the date of service, so the oldest accounts are prioritized first.
We work with VSP, EyeMed, Spectera, Davis Vision, Superior Vision, and Medicare Advantage vision carve-outs, alongside Medicare, Medicaid, and commercial medical payers. Because each plan has its own authorization, allowance, and frequency rules, our billers work directly in the payer portals to follow the requirements for each claim.
Medicare introduced two physician fee schedule conversion factors effective January 1, 2026: $33.5675 for qualifying APM participants and $33.4009 for everyone else. CMS also applied a 2.5% efficiency adjustment to non-time-based codes, meaning reimbursement can vary by service mix rather than increasing evenly across the fee schedule.
