Vision Services
AmeriHealth Caritas North Carolina (ACNC) follows the North Carolina Department of Health and Human Services’ (NCDHHS) requirements for children and adults optical covered services, including routine eye exams, medically necessary contact lenses, as well as, fitting and dispensing visual aids. The following guidance applies to ophthalmologists, optometrists, and opticians offering general and special services for children and adults.
NOTE: Providers who supply eye exams in their office must also supply Medicaid fee-for-service eyeglasses to members.
NCDHHS pays for one pair of eyeglasses, fabricated by Nash Optical, per year for children under age 21. Adults 21 to 64 can receive this benefit every two years. AmeriHealth Caritas North Carolina offers an additional pair of glasses for eligible members. Please see Second pair of glasses process below.
Step 1
Before providing any services, verify member eligibility using ACNC’s provider portal, NaviNet or by calling ACNC Provider Services at 1-888-738-0004.
Step 2
This step will help determine if the process for the first or second pair of glasses should be followed. View eyeglass history by visiting http://www.nctracks.nc.gov to review eyeglass approval history. Access is obtained via a dropdown box under the Prior approval tab marked Eyeglass service history. This assigned confirmation number is verification of the provider inquiry, not prior approval for the service. For more specific requirements, visit Clinical Coverage Policy No. 6B: Vision over age 21 (Adult) in the resource list below, page 27, Attachment C.
EPSDT
- ACNC EPSDT provider training
- ACNC EPSDT reimbursement policy
ACNC Provider Network Management Contact Information:
Inquiries regarding these processes or the ACNC extra benefit should be directed to Provider Services at 1-888-738-0004. Providers are also encouraged to contact their Account Executive for additional support.
For a complete description of services, please see the NC Medicaid clinical coverage policies and the additional resources below.
- Ophthalmology clinical coverage guideline: 1T-2 General Ophthalmology
- Ophthalmology clinical coverage guideline: 1T-1_0 Special Ophthalmology
- Optometry clinical coverage guideline: 6A Vision under age 21 (Child)
- Optometry clinical coverage guideline: 6B Vision over age 21 (Adult)
- NC DHHS Bulletins related to Optical Providers: Historical Archive
- NC DHHS Fee Schedules
- ACNC Provider Notice: Adult Vision Value Added Service June 25, 2021
- ACNC Member Newsletter Winter 2024 Get Care, Stay Well Vision Article: Do I really need a regular eye exam?