An Educational Presentation Presented by: Avesis Avesis/Wellcare Of Georgia Medicaid and Medicare Advantage Dental Providers & Staff January 2013 GA021014_PRO_LTR_ENG State Approved © WellCare GA_12_

Mission Statement Building long term partnerships to deliver valued, innovative healthcare solutions… one member at a time.

Who We Are 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

Avesis Dental  Dental Networks  Over 30,000 dentists in 41 States  Experienced Administrator  30 years serving corporate and government clients  Avesis administers Medicaid dental plans in 3 states and Medicare Advantage dental plans in 11 states

Avesis is National  Executive Offices in Baltimore, Maryland  Operations located in Phoenix, Arizona  Southeast regional office in Atlanta, Georgia

Points of Contact  Dora Wilson Executive Vice President/Health Plan Services (800) x794  Renee Ruggiero Assistant Director of Health Plan Provider Services (800) x753  Carolyn Wright Manager of Utilization Management (800) x294

Points of Contact  Tommie Howard Provider Services Representative (800) x756  Cassandra Williams Provider Services Representative (800) x805  Tonya Wilson Provider Services Representative (Medicare Advantage) (800) x715  General Provider Inquiries (800)

Clinical Professionals  Dr. Fred Sharpe Chief Dental Officer  Dr. Rick Celko Regional Dental Director  Dr. Mindy Broda State Dental Director/National Director of UM and Clinical Review

Avesis Dental Advisory Board  Committee of Georgia licensed Dentists and Avesis staff  Acts in an advisory capacity to WellCare of Georgia and Avesis in all matters pertaining to the Avesis/WellCare of Georgia Dental Programs  Helps to ensure quality communications between the Georgia provider community, Avesis and WellCare of Georgia  Forum for providers to submit recommendations and feedback regarding the programs and their administration

Eligibility

 It is strongly encouraged that you verify eligibility for each Member’s appointment the business day prior to rendering services unless the next business day is the first day of a new month.  Please note that verification of benefits or eligibility is not a guarantee of payment.

Eligibility You may obtain eligibility verification three ways: 1.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. ( or check the state website ( 2.Customer Service – Customer service is able to provide you with both eligibility confirmation as well as utilization data. You may call to reach the Customer service department. 3.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.

Fax Eligibility Verification

Benefits

Benefits Overview  Covered Services Covered services will be paid according to the plan fee schedule  Non-Covered Services Non-Covered Services may be the responsibility of the member if and only if the Member is notified of and agrees to financial responsibility prior to services being rendered

Non-Covered Services Disclosure Form This form is for your protection and the Member pays Usual and Customary Fees

Benefits Overview  Health Check (under 21) Dental Program  Peachcare for Kids Program  Adult Medicaid and Enhanced Adult Dental Program  Planning for Healthy Babies

Benefits Overview Additional Benefits & Surcharges Employees, Retirees & Employers COBRA Benefit Coordinators Rates SHBP Initiatives SHBP News SHBP Publications Regulations, Policies & Resolutions SHBP Performance Center Contact SHBP About SHBP Medicaid Applying for Medicaid Georgia Families Long Term Care Planning For Healthy Babies Medicaid Publications Medicaid Quality Reporting Medicaid & CHIP Redesign Additional Resources PeachCare for Kids Pharmacy Indigent Care Trust Fund Georgia Long Term Care Partnership You are here HomeHome » Programs » Medicaid » Planning For Healthy Babies » Client Benefits & ServicesProgramsMedicaidPlanning For Healthy Babies Client Benefits & Services Women enrolled in Planning for Healthy Babies ® who do not receive Medicaid are eligible for family planning services covered by the Georgia Medicaid program including: In addition to the family planning services listed above, women who give birth to a very low birth weight (VLBW) baby on or after January 1, 2011, and do not receive Medicaid or are losing Medicaid coverage, are eligible for inter-pregnancy care services, which offer: Planning for Healthy Babies In addition to family planning services, women who give birth to a very low birth weight (VLBW) baby on or after January 1, 2011, and do not receive Medicaid or are losing Medicaid coverage, are eligible for inter-pregnancy care services, which includes a limited dental benefit of : Two exams per year Two cleanings per year X-Rays once a year Deep gum cleaning Please refer to the Benefits Grid on Avesis.com for details

Claims

Claim Submission Claims may be submitted one of three ways:  Through your practice management software using a clearinghouse The Avesis payer identification number is  On an ADA claim form - please submit to the following address: Avesis Dental Claims PO Box 7777 Phoenix, Arizona – 7777  Utilizing our website at

Claims Follow-up 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: You may check claim status on the Avesis website at You may contact our provider services department at (800) to check claim status

Corrected Claims Submission If you are missing information (i.e. tooth number or quadrant number) or you have submitted incorrect information (wrong code, wrong tooth number, etc.) you may edit the claim on the Avesis website regardless of the method of submission. If you wish to submit a corrected claim on an ADA claim form you will need to do the following: Write corrected claim on the top of the ADA claim form in blue or black ink. The scanner does not read red ink Please do not highlight notes on the claim in blue or green highlighter. The scanner reads these colors as black so what ever they highlight is blacked out

Avesis Claims Payment  Check runs weekly  CLEAN CLAIMS processed and adjudicated within 15 business days  Payment available through EFT, Paper Checks or through Card Payment Services (CPS) via Master Card account

Prior Authorization Pre-treatment Estimates & Benefit Exceptions

Avesis Prior Approval Requirements  Services requiring prior approval are listed in detail in the provider manual and on the covered benefits schedule.  Providers may submit pre-treatment estimates on an ADA claim form to our Phoenix address or via the Avesis website at  Avesis accepts electronic attachments via the Avesis web portal.

Chart Reviews

Avesis Office Visits  Avesis conducts office reviews for our dental provider networks  Your office will be contacted in order for Avesis to schedule a time to come out  In addition to a facility walk through, providers will be furnished a list of charts prior to the visit to have available for review  After the visit, your office will be sent a letter regarding the findings of our review

Provider Services

Services to Providers  Avesis is primary for Member and Provider Services  Toll free phones staffed by experienced and knowledgeable representatives from 7am – 7pm EST at  State and National professionals involved in professional decisions regarding care and referrals  Regional meetings and training sessions scheduled for providers  Quarterly Provider Newsletters  On-site assistance in your office when available  Peer to peer interaction for Providers

Committed to Technology 24/7 Access to information:  Web Based Eligibility verification Claim submission with real time claims processing Claim status and editing Remittance advice information Pre-treatment Estimate  Interactive Voice Response (IVR) Eligibility Benefits

Thank You For Your Time Questions? We at Avesis look forward to working with you and your team.