Providers: Provider Credentialing

Application

Prospective providers must submit a Provider Application, which contains information on the provider’s education, training, professional background, licensure, DEA certificate (if applicable), evidence of Diagnostic Pharmaceutical Agent Certification, and/or Therapeutic Pharmaceutical Agent Certification.

  • Licensing

    Providers must also submit a current license, which we verify with the State Board of Optometry or the American Board of Ophthalmology and/or the American Medical Association.

  • Insurance

    All participating providers must have professional liability insurance with minimum limits of $1 million/$3 million.


Credentialing

Once we receive the competed application and required documents, it is submitted to the Avesis Credentialing Committee for review. Upon approval, the provider will receive an executed Provider Agreement and information about our program in general and our specific plans.


Re-credentialing

Every three years, providers must submit an updated application, attestation, and current credentialing documents. The provider’s performance will be evaluated, with a review of any quality of care complaints.

Quality of Care Management evaluates each practice and monitors the following:
• Quality of care
• Efficiency of care
• Member satisfaction
• Fulfillment of administrative requirement
• Compliance with clinical standards