Eligibility for every VSP and EyeMed patient, verified the night before.
Jelo checks vision and medical benefits for tomorrow's whole schedule, fills the claim from the exam note, scrubs it, submits it, posts the ERA, and puts every denial in a worklist with the reason code and the fix. Verification → claim → appeal, on one screen.
The AI biller is in development. Book a demo for early access; it is priced at 10% of insurance reimbursement, on top of the $300/month Jelo platform, which already includes eligibility at check-in, claim scrubbing, 837/835 and a denial worklist.
Last reviewed: August 30, 2026 · Jelo billing team
4.9/5 from 50 practices
Early access via demo · Free payer enrollment · No per-claim fees
What is vision medical billing software?
Vision medical billing software handles both sides of an optometry visit: the vision-plan side (VSP, EyeMed, Davis, Spectera) for the routine exam, refraction and materials, and the medical-insurance side (Medicare, BCBS, Aetna, UHC) for medically necessary exams, imaging and disease management. Jelo builds it into the EHR platform with eligibility at check-in, scrubbing and ERA posting; the AI biller add-on (in development) adds night-before verification and appeal drafting.
Generic medical billing tools do not know that a refraction goes to the vision plan while the dilated diabetic exam on the same day goes to Medicare. Jelo does, and it splits the encounter automatically. For the CPT and modifier mechanics see the billing and coding software page and the optometry modifiers guide.
Can I charge a Medicare patient for a refraction?
Yes. Refraction (CPT 92015) is statutorily excluded from Medicare, so the patient pays for it. Bill 92015 on its own line with modifier -GY, or -GA if the patient signed an Advance Beneficiary Notice, and collect your refraction fee at checkout. Medicare denies the line as patient responsibility (PR-204), which is the expected result.
Jelo's scrubber adds the -GY/-GA modifier when 92015 is on a Medicare claim and moves the refraction fee to patient responsibility so it is collected at the desk, not written off. Details in the refraction billing guide and the CPT 92015 reference.
Why does Medicare not cover CPT 92015?
Medicare does not cover CPT 92015 because refraction is part of a routine eye examination, and routine eye exams and eyeglasses are a statutory exclusion under Section 1862(a)(7) of the Social Security Act. The exclusion applies even when the visit is medical: Medicare can pay 92014 for a cataract exam and still deny the refraction performed that day.
The same patient often has a VSP or EyeMed plan that does pay for the refraction under the routine benefit. Because the AI biller (in development) verifies both plans the night before, the desk knows which payer the refraction goes to before the patient arrives. What each plan actually pays is covered in VSP vs EyeMed reimbursement 2026.
The loop that stops revenue leaking before the visit
Most denials are decided at the front desk, not in the billing office. The AI biller (in development) moves the check to the night before; the platform tools below marked without a label are live today.
Verified the night before (AI biller, in development)
Every patient on tomorrow's schedule is checked automatically. The front desk opens the day already knowing who is covered, for what, and what they owe.
Vision and medical on one card
VSP or EyeMed exam and material benefits sit next to the medical plan's copay and deductible status, so mixed visits are planned before the patient sits down.
Optometry-specific claim scrubber
92xxx vs 99xxx pairing, -25, -GY/-GA on refraction, -RT/-LT on imaging, and payer edits are checked before the 837 leaves the building.
Claim fills from the exam note (AI biller, in development)
CPT and ICD-10 codes approved by the OD flow straight onto the claim. Nothing is re-keyed into a portal or a second billing system.
ERA posts itself
835 remittances post to the patient ledger automatically, with adjustments, patient responsibility and denials sorted on arrival.
Denials with the fix attached
Each denied line shows the CARC code, what it means, and the recommended correction. Resubmit in one click; appeals drafted by the AI biller (add-on, in development).
Vision plans and medical payers Jelo verifies and bills
Eligibility runs as a 270/271 transaction, claims go out as 837P, and remittances come back as 835 ERA files through the clearinghouse. Payer enrollment is handled by the Jelo team at no cost.
| Payer | Type | Real-time eligibility | Benefits pulled | Claim submission | ERA posting |
|---|---|---|---|---|---|
| VSP (Choice, Signature, Advantage) | Vision plan | Exam, refraction, frame allowance, lens, CL, last DOS | |||
| EyeMed (Insight, Access, Select) | Vision plan | Exam, refraction, frame allowance, lens, CL, last DOS | |||
| Davis Vision | Vision plan | Exam, frame allowance, lens, CL, last DOS | |||
| Spectera / UnitedHealthcare Vision | Vision plan | Exam, frame allowance, lens, CL, last DOS | |||
| Superior Vision | Vision plan | Exam, frame allowance, lens, CL, last DOS | |||
| Avesis | Vision plan | Exam, frame allowance, lens, CL, last DOS | |||
| NVA (National Vision Administrators) | Vision plan | Exam, frame allowance, lens, CL, last DOS | |||
| Medicare Part B | Medical payer | Coverage, deductible status, coinsurance, MSP | |||
| Medicaid (state and managed care) | Medical payer | Coverage, plan, prior-auth flags | |||
| Blue Cross Blue Shield | Medical payer | Coverage, copay, deductible status | |||
| Aetna | Medical payer | Coverage, copay, deductible status | |||
| UnitedHealthcare | Medical payer | Coverage, copay, deductible status | |||
| Cigna | Medical payer | Coverage, copay, deductible status | |||
| Humana | Medical payer | Coverage, copay, deductible status | |||
| Clearinghouse (837P submission / 835 ERA) | Clearinghouse | 270/271 | Real-time eligibility transactions | 837P | 835 |
Don't see a regional plan? Any payer reachable through the clearinghouse can be enrolled during onboarding.
Three steps from the ERA to a corrected claim
The 835 lands
Jelo posts the remittance, posts what paid, and pulls every denied line into the worklist with its CARC code and remark code.
The fix is attached
Each code maps to a known optometry cause: missing -25, refraction on Medicare without -GY, wrong patient status, duplicate submission.
Resubmit or appeal
Staff apply the fix and resubmit in one click. For true appeals, the AI biller (add-on, in development) drafts the letter from the note for review.
| Denial code | What the payer means | What the Jelo worklist tells you to do |
|---|---|---|
| CO-16 Claim lacks information | A required field is missing or invalid: NPI, referring provider, place of service, or a diagnosis pointer. | Worklist shows the missing field from the 835 remark code (for example N290, N257). Fill it and resubmit as a corrected claim. |
| CO-97 Bundled into another service | The payer considers this line part of another service on the same date, most often 92015 or an E/M billed with an eye code without -25. | Confirm the services are separately identifiable, append modifier -25 to the E/M or split the claim, and resubmit with documentation. |
| PR-204 Not covered under the patient's plan | The service is excluded from the plan, typically a refraction billed to Medicare or materials billed to a plan with no hardware benefit. | Move the balance to patient responsibility, apply the -GY or -GA modifier where required, and bill the vision plan if one exists. |
| CO-4 Modifier inconsistent with the procedure | A modifier is missing or does not match the code, for example -RT/-LT on a bilateral imaging code or -25 on a procedure code. | Correct or remove the modifier per the payer edit shown in the worklist and resubmit. |
| CO-18 Duplicate claim | The same service, date, and provider were already submitted and are in process or paid. | Do not resubmit. Check claim status; if the original was paid, post it, and if it is pending, wait for adjudication. |
Jelo vs. payer portals vs. an outsourced biller
| Capability | Jelo | Payer portals / manual | Outsourced billing service |
|---|---|---|---|
| Eligibility checked for the whole next-day schedule automatically | AI biller (in development) | Sometimes | |
| Vision and medical benefits on one appointment card | |||
| Frame allowance, lens, and CL benefit visible before the visit | One portal at a time | ||
| Claim auto-fills from the exam note (no re-keying) | AI biller (in development) | ||
| Optometry-specific claim scrubber (92xxx, -25, -GY, -RT/-LT) | Generic edits | ||
| Denial worklist with reason code and recommended fix | Monthly report | ||
| Appeal drafted from the ERA | AI biller (add-on, in development) | For a fee | |
| ERA / 835 auto-posted to the patient ledger | Manual EOB entry | Separate ledger | |
| Monthly cost | $300/mo platform + AI biller add-on at 10% of reimbursement (in development) | Staff time: 10 to 20 min per patient | 4 to 8% of collections |
Two parts, priced separately.
Jelo platform
$300/month flat, whole practice. No per-provider surcharge, no per-claim fees.
- Eligibility check at check-in, vision and medical
- Optometry-specific claim scrubber
- 837 submission and 835 ERA auto-posting
- Denial worklist with CARC code and fix
- Patient statements, plus the EHR, optical POS, scheduling and recall
- Payer enrollment, ERA setup and fee-schedule import by the Jelo team, free
AI biller
10% of insurance reimbursement, no per-claim fee. Not included in the $300 platform. Early access via demo.
- Automated night-before verification for the whole schedule
- Claim auto-fill from the exam note and submission
- ERA reading with the correction applied
- Appeal drafting and follow-up until the claim pays
Compare that with 4 to 8% of collections for a billing service. Full platform pricing on the pricing page; the wider billing feature set on optometry billing software.
How verification works day to day
The night before (AI biller, in development)
At the end of the day the AI biller runs eligibility for everyone on tomorrow's schedule. For a VSP or EyeMed patient that means the exam copay, whether the refraction is covered, the frame allowance, the lens benefit, the contact lens allowance and the last date of service. For a medical patient it means active coverage, deductible status and coinsurance. Anything that fails, such as a terminated plan or a patient who used their routine exam benefit three months ago, is flagged for a call in the morning. If the patient booked by phone, the AI receptionist has already captured the plan details on the call.
At check-in
Today, staff run the eligibility check at check-in from inside Jelo. The desk sees the benefits card on the appointment, collects the copay and the refraction fee where it is patient-pay, and knows the frame allowance before the patient walks into the optical. Mixed visits are set up correctly from the start: the medical portion routes to the medical carrier, the refraction and materials to the vision plan. A longer walkthrough is in the optometry insurance verification guide.
After the exam
The OD approves the codes in the chart, the claim fills itself (AI biller, in development; today staff build it from the approved codes), the scrubber checks the 92xxx/99xxx pairing, modifiers and payer edits, and the 837 goes out. When the 835 returns it posts to the ledger, and anything denied lands in the worklist with the CARC code and the fix. Under the plan your practice's numbers are visible on one dashboard: clean-claim rate, days in AR and denial rate.
Frequently asked questions
Last reviewed: August 30, 2026
See your denial rate in 15 minutes
Bring last month's ERA. We'll show you which denials the AI biller would have caught the night before, on a real practice, live, and put you on the early-access list.
Continue exploring Jelo
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