Providers: FAQs

We’re one of the most experienced vision and dental insurance services companies in the nation, with an extensive network of providers. Since 1978, we’ve provided essential vision, hearing, and dental benefits to small and large businesses, municipalities, government agencies, and even major medical providers.

More than a million commercial members of thousands of employer groups rely on Avēsis for their vision and dental benefit services.

We cover so many vision and dental members all over the country, and Avēsis members receive a higher level of benefit when visiting in-network providers, so practices typically see an increase in new patients when they become a participating provider.

Avēsis offers our providers simple administrative processes. You can verify eligibility, submit claims, and check claim status through our secure web portal. We pay promptly for services rendered, and there is no fee to join our network.

• It's complimentary.
• Your practice will appear on our national provider directory.
• Our plan designs are easy to administer.
• Dedicated Provider support to respond to your inquiries.
• Our online and IVR tools are easy to use.
• Our customer service staff is knowledgeable and courteous.
• Clean claims have a speedy turnaround time.

Becoming a participating provider is easy and trouble-free. Click the link below, and one of our recruiters will contact you shortly to help you with the easy application process and the agreements necessary for your state.

Send us a Message

Avēsis will accept your CAQH provider numbers in place of the provider application and credentialing documents. Click the link below, and one of our recruiters will be in touch shortly to assist you with a specific state-applicable fee schedule and information about any documents required to begin the credentialing process.

Send us a Message

Once Avēsis receives all the necessary documents, you'll be credentialed in approximately 45 days. When you are approved, Avēsis will mail you a welcome letter with your Provider Identification Number (PIN) and effective date.

We try to expedite this process for new providers in participating practices as quickly as possible. Contact your Provider Services Representative for assistance.

Click the link below to send us your question, and we'll be in touch soon.

Send us a Message

Avēsis members are not required to carry their ID cards. You'll be able to verify eligibility and covered benefits prior to your patient's appointment anytime, day or night, with nothing more than the member's name and birthdate.

If an in-store promotion is a better value for the member, please extend that pricing to the member in lieu of the Avēsis benefits. Members who take advantage of the in-store special will pay you in full and submit the receipts to us for reimbursement under the group's benefit reimbursement schedule, if applicable.

Members who choose out-of-network products or services will pay you up front. No claim forms are needed, and no copays or deductables apply.

Simply log in to your portal account and enter a member's name and date of birth. That's it. Our website is available anytime, day or night.

Our website and IVR systems are available 24/7. We encourage you to verify coverage prior to the patient's appointment.

TTY calls are received and resolved using 7-1-1 or local relay services.

Our electronic claims submission and funds transfer processes are fast and easy. You'll appreciate the prompt and accurate adjudication and payment of clean claims, whether submitted electronically or on paper. Our process meets or exceeds federal or state prompt payment guidelines. Providers may submit claims to us through national clearinghouses, via the secure Avēsis web portal, or on paper claim forms.

To expedite processing, please include the approval code in block 23 of the vision claim form (CMS 1500) or box 2 of the dental claim form (ADA).

Avēsis adheres to prompt pay laws as established in each state. Where no such law exists, clean claims are adjudicated within 30 days.

Corrected claims cannot be submitted electronically. Use the CMS 1500 claim form (vision and hearing) or ADA form (dental) with "CORRECTED CLAIM" at the top of the document, and mail it to the Avēsis claims department with all applicable information.

Avēsis Claims Department
P.O. Box 38300
Phoenix, AZ 85069-8300

As an Avēsis provider, you have the right to appeal any claims that you believe have been paid incorrectly. Providers are always given the opportunity to submit any supporting documentation to be considered in the final determination. Please send all applicable information to the Claims Department address as noted above.

For information on how to update your office information please click here

When logging in for the first time to the updated Avēsis portal, providers must create a new and unique username and password.

You will need to select “Sign Up” from the Avēsis login box. This will take you to a page to create your new account. You have the option to create a Provider account or a Business Unit account.

A Provider account is an individual login for a single provider. The user can view eligibility, submit claims, or view claims for a single provider. This account type may have multiple service location affiliations.

This account is created by selecting Provider under Account Type on the Register Your Account – Sign Up page. You will need to enter your NPI and TIN number to create the account.

A Business Unit account gives access to multiple service locations and multiple providers that are associated with the same TIN. The user can view eligibility and submit claims for all locations/providers and view claims for all locations/providers associated with a single business unit.

This account is created by selecting Business Unit under Account Type on the Register Your Account – Sign Up page. You will need to enter your Avēsis Business Unit ID and TIN number to create the account. Your Businesss Unit ID can be found on your welcome letter, or you can contact your Avēsis Provider Relations representative for assistance.

If you have locked your account, simply click on "Forgot your password" in the login box. You will be asked to enter the username, first name, and last name associated with the account. Instructions on how to reset your password will be sent to the email address associated with your account.

If you forget your password, simply click on “Forgot your password” in the login box. You will be asked to enter the username, first name, and last name associated with the account. Instructions on how to reset your password will be sent to the email address associated with your account.

If you forget your username, simply click on “Forgot your password” in the login box. You will be asked to enter the email address, first name, and last name associated with the account. Instructions on how to reset your password will be sent to the email address associated with your account.

Select Medicare/Medicaid in the login box on the provider portal. Enter your username and password for your Medicare/Medicaid account, then click the “Log in to Medicare/Medicaid” box.

When submitting a claim, please be sure the user is capitalizing the H in all diagnosis codes and the V in all service codes. You must also remove the decimal from the diagnosis code. These adjustments should eliminate the error. Any claims with a date of service before 10/1/15 still require ICD 9 codes.