Government
Sponsored Programs

Elevate Expectations
Avesis has been providing essential vision, dental, and hearing care programs for millions of members for over 35 years and is recognized today as one of the fastest growing managed ancillary health administrators in the nation. Our success can be attributed to fully understanding the needs of our clients, in addition to demonstrating our proven ability to cost-effectively deliver exceptional quality and visionary solutions.

Avesis strives for excellence in all we do, and our benchmark performance in terms of member satisfaction and client retention underscores this singular focus. This is achieved through a corporate culture and operational philosophy that embraces doing whatever it takes to not only meet, but exceed, our clients’ expectations.
Rely on Experience
There is no substitute for experience. We have proven expertise in designing and administering innovative vision, dental, and hearing care programs; in-depth knowledge of the ever-changing landscape of government sponsored programs; and regulatory insight into the unique challenges facing the Medicaid, CHIP, and Medicare Advantage healthcare populations. These are vital to the success of any partnership.
Count on Quality
Your members deserve the best care available. Partnering with an industry leader who consistently delivers cost-effective, customized solutions with superior customer care and impeccable service will provide increased credibility and higher member satisfaction to your core offerings.
Choose the Single Source Solution
Through Avesis’ comprehensive array of essential vision, dental, and hearing care programs, you will benefit from consolidation to a single-source, value-added partnership, resulting in seamless, efficient administration and enhanced service.
Who We Are

Avesis is a leading ancillary benefit provider organization that has delivered superior, customer-oriented, essential vision, dental, and hearing care solutions to clients from coast-to-coast since 1978. Avesis is rapidly approaching providing ancillary benefit services to ten million members while adhering to our singular focus on improving member’s health and well-being. We strive for excellence in all that we do and our benchmark performance in terms of member satisfaction and client retention underscores this mission.
Our Provider Network

Avesis customizes its provider networks, tailoring them to best address the special needs of our clients and their covered members. All network providers are stringently credentialed in accordance with NCQA standards.

Vision: The Avesis vision care network is composed of independent practicing optometrists and ophthalmologists in addition to commercial retail chain locations in all 50 states, the District of Columbia, and Puerto Rico. This unique mix of providers blended by licensure and office location empowers our members with the ultimate choice, giving them greater access to evening and weekend office hours.

Dental: The Avesis dental care network is composed of general dentists, orthodontists, pediatric dentists, endodontists, prosthodontists, and oral surgeons in all 50 states, the District of Columbia, and Puerto Rico.

Hearing: The Avesis hearing care network is composed of audiologists and hearing instrument specialists in 48 states.
Web Technologies

Avesis uses leading-edge information management tools to keep providers and members informed. Providers and members have 24/7 access to the secure Avesis web portal.
Providers
  1. Verify member eligibility
  2. File/receive pre-treatment estimates
  3. Submit claims and X-rays
  4. Track claim status
  5. Retrieve program manuals and forms
  6. Review program-specific information and updates
  7. Access program FAQs
Members
  1. Locate participating providers
  2. Verify member eligibility
  3. Review member benefits
  4. Review program specific FAQs
  5. Nominate a provider
Claim Adjudication & Payment

Avesis has established a reputation among the managed care community as a caring and highly skilled administrator. Our claims department processes millions of claims per year — submitted through EDI, directly through the secure Avesis website, or on paper. Clean claims, whether submitted electronically or on paper, are adjudicated and paid within mandated time frames. Our providers appreciate the timeliness and accuracy of their payments. Our claims processing activities also meet established Federal rules and guidelines regarding protecting privacy and confidentiality of protected information.

Avesis consistently meets or exceeds all government-sponsored program standards. Current metrics demonstrate that our performance for financial accuracy in claims processing is trending at 99 percent, and the procedural accuracy results for claims processing is currently 98 percent.
Customer Care

Customer Care is of extreme importance to the success of any program. Avesis prides itself on the level of experience and commitment attained and maintained by its Customer Care Center.

With two strategically located call centers, the Avesis Customer Care Centers are fully staffed from 7:00 a.m. to 8:00 p.m. (EST) Monday through Friday, providing easy access and immediate responsiveness to all member needs. Current performance results show that the average speed to answer is less than six seconds, with an abandonment rate of less than one percent. Furthermore, 98 percent of all calls are handled effectively and efficiently so that no follow-up is required.

Our team wants to make a difference in the lives of others. Our Member Service Representatives are positive, caring, and compassionate. They are empowered to make the right decision for members immediately. This is part of the corporate culture at Avesis, a company with a heart that exudes a close-knit family atmosphere, internally and externally, in service to our members.
Reporting

Avesis prides itself on staying ahead of the curve with its benchmark Information Technology capabilities. We have fully integrated state-of-the-art technologies, and use the latest in hardware, software and telecommunication systems to service our health plan partners.

In addition to our cutting-edge systems, Avesis has developed a robust reporting platform with well-established processes to ensure that our data is within the highest rates for accuracy. Avesis has an outstanding record in delivering precise data, on-time/first-time, in user-friendly, client-specific formats. Even with this track record, Avesis continues to develop and implement new processes to stay ahead of the technology curve. From routine updates to procedural guidelines, to extensive and ever-changing reporting requirements, Avesis is prepared to actively meet all of your program demands.
    Standard reports/dashboards include:
  1. Utilization Reports
  2. Call Center Reports
  3. Claims Reports
  4. EPSDT Report
  5. HEDIS Reports
  6. Prior Authorization/Pre-Treatment Estimate Reports
Our robust, state-of-the-art systems allow for fast and accurate ad hoc reporting, and we welcome the opportunity to work with our clients in order to customize reports as their needs evolve over time.
Vision Programs
By leveraging over 36 years of managed vision care experience and our proven expertise, Avesis has designed quality vision care plans specifically for government-sponsored programs. Whether we are developing and implementing vision care programs from inception or improving upon existing vision care offerings, our vast knowledge is central to administering these essential benefits cost-effectively. Our commitment will be to provide your members with access to the highest quality of vision care possible, helping them to maintain good eyesight and promoting overall wellness.

Routine eye health examinations are vital tools in evaluating an individual’s overall health and wellness by aiding in the early detection and prevention of medical problems such as:
  1. Diabetes
  2. Hypertension
  3. Glaucoma
  4. Cataracts
  5. Arteriosclerosis
  6. Bacterial infections
  7. Carcinoma
  8. High cholesterol
  9. Keratoconus
  10. Stroke
Detecting these and many other disease states during an eye examination can provide cost-effective early intervention, reducing overall medical costs, improving patients’ quality of life, and increasing member appreciation. In addition, these programs can dramatically improve HEDIS scores.

As no two programs are truly identical, Avesis welcomes the opportunity to discuss how we can create an innovative, customized vision care program to best meet the needs of your covered members.
Dental Programs
By relying on decades of managed dental care experience and an exemplary track record, Avesis has designed quality dental care plans specifically for government-sponsored programs. Whether we are developing and implementing dental care programs from the ground up or improving upon existing dental care offerings, our vast knowledge and experience are certain to help you provide your members with access to the highest quality of dental care possible to help maintain good oral and overall health.

Routine dental examinations are important tools in evaluating overall health and are an invaluable tool in the early detection and/or prevention of numerous medical conditions, including:
  1. Diabetes
  2. Heart disease
  3. Pre-term low birth weight babies
  4. Osteoporosis
  5. Leukemia
  6. Lymphoma
  7. Oral cancer
  8. Pancreatic cancer
  9. Kidney disease
Dentists can detect diseases far beyond the mouth. According to the American Dental Association and WebMD, diseases and health conditions throughout the body can create revealing changes in the mouth. Through a routine dental examination, early detection can be instrumental in reducing overall medical costs, improving patients’ quality of life, and increasing member gratitude. In addition, these programs can dramatically improve HEDIS scores for health plan sponsors.

Avesis looks forward to the opportunity to discuss your program and its objectives and review how we can partner with you to create an innovative, customized dental care program that will best meet the needs of your covered members.
Hearing
Through years of industry experience, Avesis has been able to design quality hearing care plans for numerous government-sponsored programs. We can create and implement hearing care programs from initiation or improve upon existing hearing care offerings. With our experience and capabilities, we can help you provide your members with access to the highest quality of hearing care possible – an important part of complete wellness.

Avesis welcomes the opportunity to discuss with you how we can create an innovative customized hearing care program together to best meet the needs of your covered members.

About You

 

About Your Company

Dental Hearing Vision

Avēsis Incorporated and Avēsis Third Party Administrators, Inc., are wholly owned subsidiaries of Guardian. Guardian® is a registered service mark of The Guardian Life Insurance Company of America, New York, NY. ©2019 Avēsis Incorporated. ©2019 Guardian. All rights reserved. Used with express permission. #2019-76061 (exp. 4/20)


Commercial vision products are marketed and administered by Avēsis and may be underwritten and issued by Avēsis, Guardian, Fidelity Security Life Insurance Company, and National Guardian Life Insurance Company, depending on state of issue.


Amplifon is a managed discount-card program for hearing care and hearing aids provided through a third-party arrangement between Avēsis and Amplifon. Avēsis and Guardian assume no responsibility for products or services offered by Amplifon.


CBTR Optical Labs is an independent, full-service, digital lab providing optical lenses and services for Guardian and Avēsis. CBTR Optical Labs is not affiliated with Guardian or Avēsis.


QualSight® LASIK is a vision correction benefit management company that provides certain vision correcting procedures through a third-party arrangement between Avēsis and QualSight.


Medicaid, CHIP, and Medicare Advantage dental, eye care and hearing programs are administered by Avēsis Third Party Administrators, Inc., as a subcontractor to Medicaid and Medicare Managed Care Organizations. Avesis Third Party Administrators, Inc. is a wholly owned subsidiary of Guardian. Guardian® is a registered service mark of The Guardian Life Insurance Company of America, New York, NY. ©2019 Avēsis Incorporated. ©2019 Guardian. All rights reserved.


SecureADVANTAGE supplemental gap policies are marketed by Avēsis, underwritten by Fidelity Security Life Insurance Company, and administered by Special Insurance Services, Inc.