How will I know if a patient is an
Avesis member and what benefits they are entitled to?
Avesis members should present either an Avesis
identification card or, in the case of our health plan partners,
their health plan identification cards. Members may also present
a computer generated benefit summary.
If the benefits are
simply a discount program, how does the discount program work?
Or what is the discount?
There are no claim forms to complete and
no co-payments or deductibles apply. The provider collects
100% of the discount fees from the patient as indicated on
the applicable Benefit Plan Sheet. The member should present
a valid Avesis or health plan identification card, and it
is not necessary to verify eligibility. The exact discount
will depend on the members plan affiliation.
If there are in store
specials or a sale, does the member get the special or sale
price minus their Avesis benefit?
In the event that in-office promotions are a
better value for the member, Avesis Providers are required to
offer the in-store special to the member in lieu of their Avesis
vision benefits. If the member elects to purchase an in-store
special, they would pay the provider in full directly and submit
their receipts to Avesis for reimbursement under their group’s
out-of-network reimbursement schedule.
What constitutes "standard lenses"?
CR-39 plastic and glass (includes FDA hardening);
FT25, FT28, RD22 and FT7 X 28;; all powers up to +7.00 sph.
with -4.25 cylinder and +4.00 D add.
ID
Card and Eligibility Questions
What if the member doesn't have an ID card?
Providers can often verify member eligibility
via our web site or IVR with the members social security number
and date of birth. They can also contact Avesis Customer Service
at 1-800-952-6674 for assistance. Representatives are available
Monday through Friday between the hours of 7:00 A.M. and 5:00
P.M. MST. (*During daylight savings time
use PST).
What does Avesis suggest for after-hours
eligibility verification?
Avesis strongly suggests eligibility verification
be done the business day prior to the patient's scheduled appointment.
Our web site and IVR system are always available to assist our
providers. Customer Service representatives are available Monday
through Friday from 7 AM until 5 PM MST with the exception of
observed holidays.
Service
Questions and Claims
What languages do your customer service representatives
speak?
We have bilingual support (Spanish and English).
Is there a telecommunication device for the
deaf?
TDD calls are typically received and resolved
using relay service.
What is the average turn-around-time for
Avesis to pay my claim?
The Avesis benchmark for claims turn around
is to process all claims within 15 business days of receipt.
What is the process for claim adjustments
and corrections when submitting electronically?
Corrected claims should be submitted on an HCFA
1500 claim form and mailed to the Avesis claims department with
all applicable information.
What options do I have if Avesis denies my
claim?
Avesis providers and members reserve the right
to appeal any claim they feel was incorrectly denied. They are
given the opportunity to provide any additional information
they wish to have weighed into the final determination.
Is it necessary to include the approval code
on the claim form? If so, where?
The approval code should be populated in Block
23 of the claim form. Inclusion of this information can aid
in expediting claims processing time.
Why should I participate with Avesis?
Joining the Avesis panel is free and easy. Our
providers enjoy the national exposure their practices receive
as a result of our Internet site. In addition, we provide online
capabilities for verifying member eligibility and submitting
claims.
What fees should be submitted to Avesis?
Your practices usual and customary fees should
be submitted.
