Served from Node: G-3U6MOS0BYX44K
Avesis
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As the impact of coronavirus grows, we would like to provide some important updates and to assure you that you are our top priority. During the public health emergency, we have made proactive outreach attempts and updated our online directories with the information received. However many providers did not respond and we have provided the results of our best efforts. If you need dental, eye care or hearing services and cannot locate a provider, please call us and we will assist you in finding a provider that is seeing patients during this public health emergency. Providers and Benefits Managers, please log into your account to learn more. Members, click here to learn more.

Providers: 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. A CAQH application containing all required information is acceptable in lieu of the Avesis provider application.

  •   Licensing
    Providers must also submit a current license or have one present on CAQH, 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. Proof of insurance is required for participation.

Credentialing

Once we receive the completed application and required documents, it is submitted to the Avēsis 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. Upon becoming an active participant in our Provider Network you can download our Provider Manual at any time here.


Re-credentialing

Every three years, providers must submit an updated application, attestation, and current credentialing documents. This information can be submitted directly to Avesis or CAQH. 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

Provider Credentialing Forms