Providers Credentialing

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 by logging into the provider online portal.

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