Reporting
The Avesis system has robust reporting capabilities that can be
tailored to any health plan’s specific needs for timely and
accurate information.
- Utilization Reports
- Encounter Data Files
- Claims Processing Reports
- Claims Invoicing Files
- Provider Call Center Reports
- Member Call Center Reports
- Denial Log Reports
- Quarterly HIPAA Disclosures Reports
- GEO Access Reports
- Quality Improvement (QI) Reports
- Corporate Policies & Procedures
| Provider Reports |
Complaint Reports |
- Credentialing Reports
- Directories/Provider Updates
- Provider Utilization Reports
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Anti-Fraud Program Reports
- Fraud & Abuse Program description
- Fraud Activity Report
Robust Network
Avesis’ managed vision and dental care programs are built on a
foundation of robust networks. They have been designed to maximize
benefits, increase provider network access and provide the highest level
of customer service to meet the evolving needs of our health plan
partners and members.
Lower Fees
Avesis has achieved significant success in recruiting providers throughout
the geographic areas serviced.
Simplified Administration
By simplifying the administration process for providers, it has assisted with
our recruitment activities and improved provider retention.
Continuous Care
We work with our networks to maintain a consistent level of quality care
through review of claims, monitoring of complaints and appeals & on-site
visits from our Provider Services staff.
Avesis is committed to exceptional communication with our
partner health plans. We have an intimate understanding of how
to build and operate a compliant program. We do not believe in
the “one size fits all” philosophy. Each program is unique and has
nuances that must be understood and addressed. We provide our
Company’s collective expertise in delivering a tailored fit program.
Utilization Management
Utilization Management is overseen by the Chief Dental Officer,
National Dental Director for Utilization Management and Clinical
Integrity, Chief Optometric Officer and Chief Eye Medical Officer.
Clinical Protocols
• Objective and evidence-based determination criteria
• State Provider Advisory Board input, when applicable, on
clinical protocols and utilization statistics
Pre-Treatment Estimates / Prior Authorization Requirements
• Estimates/authorizations based on Members’ covered
benefits & approved CDT/CPT codes
• State licensed Provider reviewing any authorization request that
does not appear to meet pre-established criteria and
making all adverse determinations
Peer Review Committee
• Provider Advisory Board members engaged for complex
cases as needed
Over / Under Utilization Monitoring and Reporting
• Claim Payment Review
• Claim Statistical Review
• Relative Utilization Review