Application
Prospective providers must submit a Provider Application, which contains information on the provider’s education, training, professional background, licensure, DEA certificate (if applicable), evidence of Diagnostic Pharmaceutical Agent Certification, and/or Therapeutic Pharmaceutical Agent Certification.
- Licensing
Providers must also submit a current license, which we verify with the State Board of Optometry or the American Board of Ophthalmology and/or the American Medical Association.
- Insurance
All participating providers must have professional liability insurance with minimum limits of $1 million/$3 million.
Credentialing
Once we receive the competed application and required documents, it is submitted to the GVS National powered by Avēsis Credentialing Committee for review. Upon approval, the provider will receive an executed Provider Agreement and information about our program in general and our specific plans.
Re-credentialing
Every three years, providers must submit
an updated application, attestation, and
current credentialing documents. The
provider’s performance will be evaluated,
with a review of any quality of care complaints.
Quality of Care Management evaluates
each practice and monitors the following:
• Quality of care
• Efficiency of care
• Member satisfaction
• Fulfillment of administrative
requirement
• Compliance with clinical standards
Provider Credentialing Forms
Re-credentialing Applications
Disclosure of Ownership Forms