Starting on Sept. 1, 2025, visual aid prior authorization requests entered into NCTracks with a rendering provider National Provider Identifier (NPI) that is not an individual will not be accepted.
Frames, lenses, contact lenses and other visual aids requiring a written prescription are federally required to be ordered by a physician or other licensed practitioner. On the detail tab for visual aids, the individual rendering provider NPI must be an optical provider (ophthalmologist, optometrist or optician) in the practice or the individual eye doctor who wrote the visual aid prescription.
Nothing has changed regarding the requesting provider information on the header tab. Providers must continue to enter the requesting provider information including the address to which Nash Optical plant will ship the eyeglasses.
The billing provider may be an organization or an individual. If the billing provider is an organization, do not check the box on the detail tab indicating that the billing and rendering provider are the same.
Billing/Claims
Effective for dates of service on or after Nov. 1, 2025, claims for the following visual aid procedure codes V2510, V2520, V2799, V2600, V2610 and V2615 must include an individual ordering provider NPI. Claims that fail to meet this requirement will be denied and the Remittance Advice will display either EOB code 02438 - Ordering provider is required or EOB code 02439 - Ordering Provider Must Be Enrolled as an Individual Provider.
Enrollment
Based on prior authorization and claim changes, optical providers (ophthalmologists, optometrists and opticians) should review NCTracks enrollment status to ensure there is an individual Optical provider enrolled at the practice location where the visual aids are being ordered. See additional enrollment instructions in the previously-published Important Updates for Opticians Medicaid Bulletin.
Contact
NCTracks Call Center: 1-800-688-6696