Avesis Credentialing Process
Avesis and its participating providers are committed to setting the standard in the vision care industry.
Avesis has developed a Quality Assurance Plan designed specifically to ensure that all members receive quality vision care.
Avesis thoroughly recruits and retains high quality vision care providers. This is accomplished through our exhaustive credentialing process, evaluation and re-credentialing programs.
Avesis carefully screens each of its affiliated providers to ensure that all quality assessment standards are met. All providers are subject to initial credentialing which closely evaluates their professional training and identifies the range of vision services they are qualified to render.
Each prospective provider is required to submit a Vision Application that contains information on education and professional background, current licensure to practice optometry or ophthalmology, Drug Enforcement Agency license, if applicable, and applicable certificates to dispense controlled substances or therapeutic agents.
All providers must demonstrate a valid license with no pending quality of care complaints. This is verified with each respective State Board of Optometry or the AMA for MD's and the National Practitioner Data Bank.
All providers must have adequate professional liability insurance. Providers must also be free of any malpractice claims either resolved or pending.
If a prospective provider meets all of the credentialing criteria, the provider agreement will be executed and all administrative, plan data and group care information will be issued to the provider.
The re-credentialing process occurs every three years. It involves an evaluation of the provider’s performance, including any complaints on-going or adjudicated during the year of care. There are also re-verification of credentialing documents such as the professional license professional, liability insurance, DEA registration certificate, and other applicable documents. Respective State Boards of Optometry are queried concerning any adverse actions against the license of the provider.
Those providers who have not demonstrated compliance with or adherence to Avesis credentialing, performance and/or vision practice standards will not be re credentialed or retained within the provider network. Non-compliant providers will be notified of such action and may formally appeal for reinstatement.
The Quality of Care Management evaluates each practice and monitors the following:
- Quality of Care
- Efficiency of Care
- Member Satisfaction
- Fulfillment with Administrative Requirements
- Compliance with Clinical Standards