Average overall user rating for dentists who take avesis. May 15, 2019 provider billing instructions are displayed in adobe acrobat formats. Average profilepoints score for dentists in kentucky who take avesis. Medicaid documents and forms for kentucky enrollees humana. Throughout your ongoing relationship with avesis, this dental provider manual will provide you with useful information concerning the avesis dental program. To submit claims electronically, health care providers need to use an electronic claims clearinghouse. Mcg is available either verbally or in writing for kentucky dms, practitioners, the public or enrollees on request. We are working with patients and dental providers across the state to make oral health care more affordable and easier to access with a focus on prevention.
Dec 03, 2020 become a wellcare vision, dental or hearing provider. Dental provider agreement ky revised 08042011 avesis. We are pleased that you have chosen to participate with us. This provider manual was created to assist you and your office staff with providing services to our enrollees, your patients. We have over 30 years of experience serving medicaid populations including children, adults and people with disabilities or other serious health conditions. Average overall user rating for dentists in kentucky who take avesis. Kentucky medicaid mco prior authorization request form. On average late and senile people tend to turn to the dentist for tooth extraction and prosthetics. Your child must get a dental exam before they start kindergarten. The area consists of trained, skilled staff who respond to both written and telephonic inquiries. Feb 26, 2021 provider telehealth or telephonic health services faqs. And this, in turn, has an active influence on the development of the avesis dental providers. Your dental care is covered by avesis providers in our network.
So in dentistry there are many other different directions. If avesis receives an eligibility inquiry from a provider who has a member in the office and is stating heshe is a passport member but the member does not appear on the eligibility file, avesis may contact passport provider services at 8005780775. Provider type pt the first two digits of the ky medicaid provider number. Providers and benefits managers, please log into your account to learn more. If you are interested in becoming a vision, dental or hearing provider, please use these contacts. Dental managed care information page content with the passage of the medicaid reform law pa 961501 pdf, at least 50 percent of the hfs medicaid clients are required to be enrolled in a care coordination program that is patientcentered, with focus on improved health outcomes, enhanced patient access and patient safety. Guardian government healthcare, with our subsidiary avesis. Find provider information and materials for humanas managed medical assistance mma program specific to kentucky medicaid coverage. Guardian is a registered service mark of the guardian life insurance company of america, new york, ny.
Your dental and visioncare benefits are available to you through our partnership with avesis third party administrators, inc. Avesis dentists listed on have been practicing for an average of. Provider agrees to comply with the contents of the provider manual as well as the policies and procedures set forth in the provider manual, as it may be revised by avesis from time to time. The hours for the provider services department are.
If you are not registered with humana caresources provider p ortal. Contracted providers must acknowledge this provider manual and any other written materials provided by molina as proprietary and confidential. Get provider manuals, plan sheets, lab program forms, and more. This manual provides dental providers in the upmc dental advantage network with an easytouse guide to the health plans practices. Dental provider manual general information avesis incorporated, the parent company of avesis third party administrators, inc. Enter your username and password, then click the provider login button. We appreciate your participation and look forward to partnering with you to improve the oral health of your patients and to grow your practice.
To enroll or bill kentucky medicaid, dental service providers must be. Humana healthy horizons in kentucky department phone faxother general provider services contact information 1 800 444 97 direct authorization intake contact information for medical and behavioral health 1 888 285 1114 1 833 974 0059 dental avesis 1 888 211 0059 vision avesis 1 844 511 5760. Avesis shall transmit payments to provider on a timely basis in accordance with the states prompt pay laws and the terms and conditions of this agreement. She practiced general dentistry for 10 years in mount sterling, kentucky, worked in state government, focusing on health care policy and regulation, and managed a district health department north of. Provider relations is the first line contact for medical providers questions. Information in this provider manual will be updated on the avesis and passport advantage websites at and it is the provider. A user manual is available for downloading and is designed to assist you in navigating through the system. In our kentucky medicaid dental market, where we manage dental benefits for 80 percent of the market, our prescribing program reduced the number of dentists writing opioid prescriptions at rates that exceed the states recommended guidelines. Development of dentistry and avesis dental providers.
Coventrycares of kentucky provider relations team dental. Theresa mayfield of dentaquest spoke about dental benefits as the 1115 medicaid waiver is implemented in 2019. Kyhealth net is a webbased system designed to allow medicaid providers instant access to pertinent member information, claim inquiry, pa inquiry, ra viewer and claim submission. Recognizing that every client is unique, avesis has built a network of dentists and dental specialists to support the constantly growing needs of the medical. Status of my rewards program and kentucky health e. Celebrities, for example, turn to the dentist for teeth whitening. Kentucky medicaid provider manual for humana caresource. Avesis shall establish and enforce policies and procedures designed to ensure avesis and providers continued compliance with applicable. Tracy williams, program manager for kentucky health, spoke about the reapproved 1115 medicaid waiver. If you need dental, eye care or hearing services and cannot locate a provider, please call. Billing instructions are for fee for service ffs providers only.
The avesis website also contains important information including but not limited to dental alerts, eligibility verification, claims submission and claims status. Kohc 2018 annual meeting recap kentucky oral health coalition. Dentist providers who are participating under this agreement are listed on the signature page. Dental provider manual avesis contact information avesis executive offices avesis corporate offices 10324 south dolfield road 3030 north central avenue, suite 300 owings mills, maryland 21117 phoenix, arizona 85012 410 5818700 602 24400 800 64312 800 5220258 avesis provider services avesis utilization management avesis eye providers. The provider manual is incorporated herein by reference and the terms of this agreement shall control the interpretation of the provider manual. Kentucky state dental plans medicare, medicaid, chip dental. Avesisdentists in kentucky listed on have been practicing for an average of. Mar 25, 2021 our provider manual is a resource for working with our health plan. Providers should see adjustments on the cycle dated feb.
And the avesis dental is directly related to dental services. The kentucky medicaid program should not be confused with medicare. Outofstate providers must be licensed by the kentucky board of dentistry. For providers and practitioners, the process to obtain criteria is communicated annually in the provider newsletter and in the provider manual. Kentucky medicaid has issued guidance to providers regarding covid19. Providers can contact simply and cha at 8444054296 for vision plan information.
This manual communicates policies and programs and outlines key information such as claim submission and reimbursement processes, authorizations, member benefits and more to make it easier for you to do business with us. Dental services pt 60 61 cabinet for health and family services. Kyhealth net system cabinet for health and family services. Dentists in kentucky who are confirmed as being board certified and take avesis. Our dental provider manual is intended to be a comprehensive reference tool to hel. Dental office progressive dental solutions in pittsburgh, pa. Once the provider has submitted a complete application including all of the required credentials, the information is submitted to the avesis credentialing committee for approval. Fee schedules cabinet for health and family services. Jan 01, 2021 find all the medicaid documents and forms you need to stay organized including member handbooks, provider directories and preferred drug lists. Dental services are recognized by kentucky medicaid as provider type 60 individual or 61 group. Covid19 kentucky healthcare provider update pdf epsdt provider toolkit pdf epsdt resource packet pdf kentucky medicaid physician administered drug list pdf progenyhealth faqs pdf provider manual pdf provider priority of preferred files pdf provider phone access guide pdf provider prior authorization list pdf provider. Avesis has been providing fully insured dental and vision services since 1978.
Aetna better health of kentucky is part of aetna, one of the nations leading health care providers and a part of the cvs health family. The mechanisms and equipment used by dentists are actively modernized. March 16, 2020 covid19 alert for the latest information on the novel coronavirus in kentucky, please visit kycovid19. Julie watts mckee received a degree in biology from the university of kentucky, and a dental degree from the university of louisville in 1983. The purpose of the provider manual is to provide you with an explanation of administrative procedures, provisions and the role you play as a dentist. Please refer to the dms provider enrollment website for specific forms and documentation required for enrollment. Members should present a kentucky passport medicare advantage card. Mahak klara, kentucky youth that beginning this month, avesis will become the dental provider. Avesis shall make available to provider the avesis provider manual provider manual for use during the term of this agreement. Tac information request b eligibility problems continue but are being worked on refiling costs to the office numerous dates in february, march and april of patients not being eligible for dental. This provider manual may be changed or updated periodically.
Refer to the user manuals section listed on the right. Dental provider manual avesis contact information avesis executive offices avesis corporate offices 10324 south dolfield road 3030 north central avenue, suite 300 owings mills, maryland 21117 phoenix, arizona 85012 410 5818700 602 24400 800 64312 800 5220258 avesis provider services avesis utilization management. Welcome to the kentucky medicaid management information. Providers may see adjustments negatively or positively impact claims reimbursement for services from jan. Dentaquest is on a mission to improve the oral health of all. Provider manuals georgia department of community health. Enter your provider name, tax id, humana caresource provider id and zip code. The provider manual is a resource for working with our health plan.
Caudill, dmd, fagd, magd, cdc, ctcp, fpfa, ficd, facd, is associate national dental director and kentucky state dental director for avesis, a guardian company. A list of clearinghouses preferred by humana caresource is included below. Percentage of avesis dentists who are listed as board certified on. Development occurs in the methods of treatment used. We cover adults and children under 21 for dental care. As a provider, you agree to use this provider manual as a reference pertaining to the provision of medical services for enrollees of amerihealth caritas dc. Avesis fill online, printable, fillable, blank pdffiller. Dental service provider coverage for adults is limited but includes oral exams, emergency visits. For more details on payspan please refer to your provider manual. Upon approval, the participating provider will receive an executed provider agreement and information regarding program specifics, how to obtain a provider manual, and. If you require assistance or information that is not included within this provider manual, please contact our dental benefit administrators provider services department, avesis by phone 866 9091083. Avesis would like to take this opportunity to welcome you and your staff as members of our national network of preferred providers. Dme updated notice due to the ongoing covid19 public health emergency, medicaid has suspended the 2020 dme fee schedule changes due to become. Provider manuals a complete copy of wellcares provider manual is available online, including all of the necessary forms and educational materials.
The avesis kentucky medicaid provider manual for humana. When communicating with our participating providers, we make every effort to be clear and concise. Recognizing that every client is unique, avesis has built a network of general and specialty providers to. In just six months, we reduced the number of high prescribers by 70 percent. Our expectation is to answer questions promptly when they arise. Total number of dentists in kentucky on who accept avesis. This provider manual shall serve as a supplement as referenced thereto and incorporated therein, to the molina healthcare of ohio, inc.
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