An Educational Presentation. Prepared For:. Avesis/Wellcare of Kentucky Dental Providers & Staff. Presented by: Avesis. September 2012. Mission Statement. Building long term partnerships to deliver valued, innovative healthcare solutions… one member at a time.
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An Educational Presentation
Avesis/Wellcare of Kentucky Dental Providers & Staff
Presented by: Avesis
Building long term partnerships to deliver valued, innovative healthcare solutions… one member at a time.
Dental, Vision, and Hearing Plan Administrator working with employer groups and health plans nationally
Over 30 years experience in the dental, vision, and hearing insurance industry
Covering over 4.5 million members throughout the country
You may obtain eligibility verification four ways:
IVR – Please bear in mind that this only provides you with information as to whether or not the member is eligible on the date of service. It does not provide utilization data
Website – This method provides you with information as to whether or not the member is eligible on the date of service and allow you to view the members utilization history. (www.Avesis.com or check the state website https://sso.kymmis.com)
Customer Service – Customer service is able to provide you with both eligibility confirmation as well as utilization data. You may call 855.214.6776 to reach the Customer service department.
Fax – You may utilize the form found of the following slide for eligibility confirmation. This form will provide you with both eligibility confirmation and utilization data.
The Global Choices Program
Global Choices is the benefit plan for most Kentucky Medicaid members. This plan covers basic medical and dental services. There are no co-pays for any dental services for Wellcare of Kentucky members enrolled in Global choices. Some service limits can be increased if the service is medically necessary (requires prior approval).
Benefits for Global Choices
The Family Choices Program
Family Choices is the Kentucky Medicaid benefit plan for most children. This plan covers basic medical and dental services. Kentucky Children’s Health Insurance Program (KCHIP) is part of the Family Choices Plan. This is not a complete list of services. Some benefit limits can be increased if the service is medically necessary (requires prior approval).
Benefits for Family Choices
This form is for your protection and the Member pays Usual and Customary Fees
Claims may be submitted one of three ways:
Avesis Dental ClaimsPO Box 7777Phoenix, AZ 85011 – 7777
Providers receive remittance advices detailing claims both paid and denied. If you believe you have not received status on a claim, you may check the status of submitted claims two ways:
Pre-treatment Estimates & Benefit Exceptions
24/7 Access to information:
We at Avesis look forward to working with you and your team.