Ophthalmology and Retina
Payer Operations for Ophthalmology and Retina Practices
Injection and drug authorizations under the medical benefit, step-therapy administration, surgery and laser approvals, benefits investigation, claims follow-up on office-administered drugs, appeals, and credentialing, handled within your systems by Ellery’s U.S.-based team, with every clinical decision staying in your practice.
What lands on our desk
- Medical-benefit prior authorizations for intravitreal injections, including step-therapy and preferred-agent requirements that name the drug sequence a payer expects
- Reauthorization tracking for ongoing injection series, including visit counts, intervals, and expiration dates
- Benefits investigation for office-administered drugs, including buy-and-bill versus specialty-pharmacy determination and patient-responsibility estimates
- Hub enrollment, copay-assistance enrollment, and patient-assistance-program paperwork
- Authorizations for cataract, glaucoma, corneal, and oculoplastic procedures and laser treatments, including site-of-service and facility requirements when applicable
- Payer documentation requirements for imaging such as optical coherence tomography, fluorescein angiography, and visual field testing
- Claims status follow-up, underpayment review, and payer correspondence for drug and procedure claims
- Denial and appeal administration, provider credentialing, CAQH maintenance, and payer enrollment
Administrative demands in ophthalmology and retina
Retina and comprehensive ophthalmology practices carry medication-access and procedural payer work at the same time. Intravitreal therapies may require prior authorization, preferred-agent sequencing, reauthorization, and benefit verification, while buy-and-bill drugs add reimbursement exposure once medication has been acquired and administered. Surgical and laser cases bring separate procedure, documentation, and site-of-service requirements. A defined workflow that tracks approval periods, treatment intervals, and claim status alongside the surgical schedule gives that work a dedicated owner.
How a case runs here
Ellery Health Partners locates and organizes the documentation the payer’s published criteria require, flags anything missing to your coordinator, submits through the channel your practice approves, monitors status, completes routine payer follow-up, coordinates routine additional-information requests from the record, and records every action, reference number, and outcome in your system. If a request is denied, Ellery Health Partners records the payer’s stated reason, the deadline, and the directed next step, and administers the appeal where that is in scope.
What stays with your practice
Clinical decisions, medical necessity, prescribing decisions, diagnosis and procedure code selection, physician peer-to-peer reviews, provider signatures and attestations, and clinical answers to payer questions remain with your clinicians. When a payer asks a clinical question, Ellery Health Partners documents it and routes it to the contact you designate.
Get started with Ellery Health Partners
Tell us about your practice, your approximate monthly volume, and the support you need. We review your workflow, confirm the scope, and send the agreement and onboarding documents. No patient information is requested or accepted.