Claims

Filing out-of-network vision claims with Anagram’s API

Assignment of Benefits (AOB)

• Assigning benefits to the provider (you) allows you to immediately charge the patient the net price, effectively lowering the upfront out-of-pocket for the patient
• VSP is the only vision insurer that supports the Assignment of Benefits (AOB).
• For all other insurers, reimbursement is sent directly to the patient, not to the provider.

Claim processing and timelines

• Reimbursements are typically processed within 2–4 weeks from the time of claim submission.
• Payments are sent via paper mail.
• Currently, there is no reliable way to track the status of claims after submission.

Claim payments and reimbursement expectations

While we aim to provide accurate estimates regarding patient eligibility, coverage, and reimbursement amounts, these are not guaranteed, and final details will only be confirmed once the insurer processes the claim.

Actual reimbursement may vary slightly from the initial estimate provided. We recommended communicating this uncertainty to patients to set appropriate expectations.

Workflow suggestions and best practices

Using the eligibility response

The eligibility response often contains useful information that you should include on the claim. If you do this, you do not need to ask the patient for it. It can include the patient’s name, date of birth, member ID, address, phone, and more. We recommend using the insurer’s data as it will decrease the likelihood of rejections.

You can technically submit claims without checking a patient’s eligibility, but we don’t recommend it. This will result in an increased number of rejected claims.

Hold periods

• Wait for any order hold period to pass
• Re-run eligibility checks to confirm up-to-date information
• Use the eligibility response to populate claim fields automatically and submit the claim

Canceling claims

After you submit a claim to us, there is a brief holding period during which cancellations may still be possible. This window is intended to allow for last-minute changes or corrections before the claim is transmitted to the payer. You can view and cancel claims directly in the Anagram App.

Once the claim has been officially submitted to the payer, it is no longer possible to cancel it through our system. At that point, any updates, cancellations, or corrections must be handled directly with the insurance company.

We would recommend carefully reviewing all claim details and making sure they’re clear before final submission to reduce the need for cancellations or follow-ups.