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Section 3: Provider and Member Resources

3.1 Provider Resources

Overview

AHP provides multiple ways for Providers and Members to ask questions and receive information.  When Members have questions about the health plan, Providers are encouraged to direct Members to the resources listed in this section. AHP is committed to providing outstanding services with information, education, direction and support to all its Members, Providers, customers, and staff. 

 

Network Services Representatives

Dedicated Network Services Representatives are available and responsible for providing exceptional service to participating Providers.  The Network Services staff is the Provider’s first point of contact when issues arise regarding the following topics:

• Contract  language and/or fee schedule negotiations
• Training and education
• Overall plan operations
• Plan policies and procedures
• Ensuring the integrity of the Provider’s data in health plan records
• Site visits

Network Services Representatives are committed to being a valuable partner to all Providers in the network.  For assistance in contacting your Network Services Representative, please contact the Network Services Department at 605-322-4545 or toll-free at 1-888-322-2115.  Feel free to email inquiries to providers@averahealthplans.com .

 

Avera eView

Available at www.averahealthplans.com , AHP Providers have online access to HIPAA compliant information that is tailored to meet the Provider’s specific needs. Once you have a user ID and password you will be able to log on to your home page.  From there you will be able to quickly perform membership eligibility inquiries and check on claim status, all in real time.  For additional convenience, eligibility searches can be done either individually or in a batch process.

To obtain more information about Avera eView, please contact the Network Services Department at 605-322-4545 or toll-free at 1-888-322-2115.

 

Provider Communications

 

Website

The AHP website contains the most up to date information available.  Visit www.averahealthplans.com and select “Provider” to view communications and resources available to Providers.

Provider Directory

A listing of participating Providers can be found in the Provider Directory.  The directory is accessible online at www.averahealthplans.com. To obtain a list of participating Providers for one of our members, visit the Provider page and select the link “access patient specific benefit information.”  Simply enter the Member’s Group ID Number to get started.

ProviderView 

The ProviderView is a newsletter that is published and available to view by participating Providers on a quarterly basis.  Included in the newsletter is information on timely health trends and topics, Provider updates, current AHP initiatives and other relevant information.  The ProviderView is found online at www.averahealthplans.com/ahp/provider/newsletters .  If you would like to receive the ProviderView by email, please send your request to providers@averahealthplans.com.

AHP Provider Manual

Located on the website, the manual includes information relating to AHP, as well as policies and procedures relating to Providers. 

 

Member Eligibility Verification

Per the AHP Provider contract, Providers are responsible for assuring a Member is eligible for coverage prior to rendering covered services, except for emergency services.  AHP Member eligibility can be verified by one of the following methods:

• Verify Member eligibility status and other Member benefit information online using Avera eView located on the Provider page of the AHP website.  To use Avera eView, please call a Network Services Representative to obtain access information.  Phone: 605-322-4545 or 1-888-322-2115. 
• Contact the AHP Service Center at 605-322-4545 or toll-free at 1-888-322-2115 to speak with a Customer Service Representative who can verify Member eligibility. 
  

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