Frequently Asked Questions

Coverage Questions
ID Card and Eligibility Questions
Service and Claims Questions
Coverage Questions

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 Monday - Friday .

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 Monday - Friday 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.