Your Most Frequently Asked Questions

The questions below are presented in descending order based on call volumes reported by the Provider Service Center.  Since most, if not all of the questions listed below are addressed in your Physicians Reference Guide, whenever possible we will take you to the specific page in the Physicians Reference Guide where the answer is located and where additional information may be found.

Once in the Physicians Reference Guide, you may scroll for additional information or search for information anywhere in the document.  You may request a hard copy of the Physicians Reference Guide from the Provider Service Center via e-mail ( ) or by calling (800) 452-8633.

Q1: What are AvMed's Products?
A1: You will find our current list of non-Medicare products on our Products, Designs, and Descriptions page.  Our Medicare products are listed in the following table:

AvMed's Medicare Products At A Glance for Physicians & Care Providers
Product Name	Product Description
Medicare Premier Care (white ID card)	A Medicare Advantage HMO plan that uses a full network of AvMed participating Primary Care Physicians, Specialists, Hospitals, and other providers located in Miami-Dade and Broward counties. A member can use any provider who is part of the AvMed Premier Care Network.
Medicare Preferred PPO (white ID card)	A Medicare Advantage PPO plan that uses a full network of AvMed participating Primary Care Physicians, Specialists, Hospitals, and other providers located in Miami-Dade and Broward counties. A member can use any provider who is part of the AvMed Medicare Preferred PPO Network or providers who accept Medicare but do not participate in AvMed's Medicare Preferred PPO Network at a nonparticipating provider rate.

Q2: How do I enroll as a provider with AvMed?
A2: The first step would be to complete and provide the Provider Interest Form to the Provider Service Center,  here are the options currently available...

• You can download the Provider Interest Form, complete and fax to number indicated on the form.
• Send an e-mail ( ) to the Provider Service Center requesting the form.
• You may contact the Provider Service Center at (800) 452-8633 to request the form.
   

Q3: Which services require authorization?
A3: Effective April 1, 2005, AvMed implemented a new streamlined authorization platform with minimal authorization requirements.  Authorization will not be required for simple referrals/consultations to participating specialists.  Also, authorizations for most services provided in a participating physician’s office would not be required.

For the services below, the prescribing physician should submit an Authorization form via fax to (800) 552-8633.  If the service is deemed emergent or urgent, please contact the Authorization Department directly at (800) 816-5465.

• Inpatient Hospitalizations (Acute, Observation, Skilled Nursing, and Rehabilitation admissions)
• Outpatient Surgery (including cardiac catheterization and angioplasty procedures)*
• Diagnostic testing facilities for Complex Radiological Procedures (CT, CT Angiography, MRI, MRA, and Pet Scans)*
• Outpatient Infusion Services and Injection Therapy*
• Hemodialysis
• Home Health Care*
• Transplant Services
• All Outpatient Drug Infusions Services and Injection Therapy*
• The following drugs when provided in the physicians' office:
• Procrit, Epogen, Neulasta, Aranesep, IVIG delivered by infusion, Remicade, Alefacept, and Synagis
• Non-Participating Physician, Facility, and Ancillary Providers*

* These services do not require authorization for Members who are covered by our Choice product or our POS product while using the POS benefit for non-participating providers.
 

Q4: Which medications require authorizations?
A4: The authorization requirements for prescription drugs has not changed.  For more information regarding Dispensing Limits, Coverage Guidelines and formulary listings please refer to Chapter 4 - Member Benefits of the Physicians Reference Guide.  Please check for a designation of "PA" which indicates that a medication requires authorization.

 

 

Q5: For which services can a member self-refer?

A5:  Click here to see the list of services for which Members may self-refer.  While in the Physicians Reference Guide you may want to review Pre-Authorization Policies and Procedures section of the guide.

 

 

Q6: How do I fill out an Authorization Request Form?

A6: When filling out the Authorization Request Fax Form, please make certain that the information outlined below is provided...

• Member Information including Member Name, Member ID# and the Member's DOB.
• Requested Service such as Simple Referral, In Office Procedure or Diagnostic Procedure.
• Provider Information including the "Requesting" Provider Name, Provider # Phone/Fax number, "Referred to" Physician/Facility Name and Provider #.
• Diagnosis Code(s)/Narrative
• CPT4 Code(s)/Narrative
• Supporting Documentation such as pertinent lab values, x-rays and progress notes.

Q7: How can I see the participation status for a specific Provider?

A7: Here are the options currently available...

• You may access our Online Provider Directory, once there you may search for Primary Care Physicians, Specialists, Group Practices, Hospitals, Urgent Care Centers among others by using Name, Language, Gender, Specialty, County, City and Zip Code as the search criteria.
• You may contact the Provider Service Center at (800) 452-8633.

Q8: How can I locate other Providers by their type of product such as Commercial, Medicare?

A8: Here are the options currently available...

• You may access our Online Provider Directory, once there you may select Product and geographical Region in which to search for Primary Care Physicians, Specialists, Group Practices, Hospitals, Urgent Care Centers among others by using Name, Language, Gender, Specialty, County, City and Zip Code as the search criteria.
• You may contact the Provider Service Center at (800) 452-8633.

Q9: How can I update my name, office addresses or telephone numbers?

A9:  Here are the options currently available...

• Download and fax the Directory Information Change Form to our Provider Service Center at (305) 671-6149, or toll free at (877) 231-7695.
• Elect to send an e-mail message ( ) requesting the necessary changes.
• You may call the Provider Service Center directly at (800) 452-8633.

Q10: How can I request the Link Pads?

A10: Here are the options currently available...

• You may view and download the Link Pad, once downloaded you may print for future use.
• Send an e-mail ( ) to the Provider Service Center requesting the form.
• You may contact the Provider Service Center at (800) 452-8633 to request the form.

Q11: Where can I find the Authorization Request Form?

A11: The are several ways to get the form, here are the options currently available...

• You may download, save the Authorization Request Fax Form, which you may save and print for future use.
• Send an e-mail ( ) to the Provider Service Center requesting the form.
• You may contact the Provider Service Center at (800) 452-8633 to request the form.

Q12: Are there other forms I can download?

A12: Yes, to view all forms available for download, click here.