Dental
Avēsis administers MississippiCAN and CHIP Dental benefits for Molina Healthcare of Mississippi.
Dental Claims
Please note that when submitting a dental claim to Avēsis, via the provider portal, clearing house or ADA claim form, the member ID must include the preceding five zeros (00000) as part of the Member ID to receive payment.
Claim filing information
- Avēsis Provider Portal – to gain access contact your provider relations representative
- Clearinghouse Submission – Avēsis Payor ID -86098
- On a claim form to: Avēsis Dental Claims | P.O. Box 38300 | Phoenix, AZ 85069-8300
Dental Prior Authorizations
Prior Authorization of Dental Treatment in an Outpatient Hospital or Ambulatory Surgical Center setting must be submitted as follows:
- Providers should submit request using ADA code D9999 with the required Molina Mississippi Hospital Worksheet and all services that are requested to be performed on the ADA Claim form.
- Prior Authorization should be submitted on the Avesis Provider Portal Avesis Provider Portal. To gain access contact your provider relations representative
- Mississippi Hospital Worksheet
- If approved, Avēsis is to submit the Molina Mississippi Hospital Worksheet to Molina including the Avēsis dental approval to review and determine the approval of the Outpatient Hospital or Ambulatory Surgical Center facility.
- Provider will notify facility of approval. Facility will request prior authorization from Molina.
- A copy of the determination will be sent via mail to the provider and member.
- If denied, the provider and member have options listed for the appeals process on the notification received.
*Please note that all provider fax, and email information must be kept up to date*
If you have any questions, please contact your designated Avēsis provider relations representative
Kari Lewis
dental provider relations
410.413.9206
klewis@avesis.com
Jarhonda Brown
dental provider relations
410.413.9113
jlbrown@avesis.com