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2023 Medicaid Updates for Dentists in Illinois

Some new insurance updates that affect claims submission, EOB management, and payment reconciliation have come to light. To help you navigate this new dimension, we bring you key updates you should know about. This will help you make informed decisions with your claims and act quickly where necessary. 

We’ve highlighted some important information for you below. 

Catch Up on Insurance Updates

As of January 1, 2023, Avesis stopped being the administrator of dental benefits for Molina Healthcare of Illinois Medicaid plan and Molina Dual Options Medicare-Medicaid plan in Illinois. However, Avesis will still process all eligible claims with dates of service on or before December 31, 2022. 

You must note the important filing dates and their deadline to ensure you stay compliant. 

Molina Healthcare of Illinois Medicaid plan Deadlines

  • File and correct an initial claim 180 days from date of service
  • Correct a claim 90 days from the last EOB date after the timely filing limit has expired
  • Appeal a claim 90 days from last EOB date
  • Submit a claim with primary EOB 90 days from date of primary payer’s remittance advice

Molina Dual Options Medicare-Medicaid plan in Illinois

  • File and correct an initial claim 365 days from date of service
  • Correct a claim 90 days from the last EOB date after the timely filing limit has expired
  • Appeal a claim 30 days from last EOB date
  • Submit a claim with primary EOB 90 days from date of primary payer’s remittance advice

When billing Avesis for claims with a DOS before December 31, 2022, you can file claims through the following three formats.

  • The first format is going through Avesis secure web portal. Proceed to the portal and follow the prompts to bill Avesis. 
  • Clearinghouses: Avesis has three clearinghouses through which you can file your claim. These include Change Healthcare (Payer ID: 86098) (1-888-255-7293), DentalXChange (Payer ID: 86098) (1-800-576-6412), Tesia (Payer ID: 86098) (1-800-724-7240)
  • The final option is sending a completed paper ADA claim to:

Avesis Third Party Administrators, Inc. 

ATTN: Dental Claims

PO Box 38300

Phoenix, AZ 85069-8300

2023 Changes Avesis Billing

Starting in January 2023, you will need to use Payer ID AVS02 (dental) to avoid claim rejections and payment delays. Your billing team at Versa Solutions will make the necessary changes in your software for clean claims submission.

Speak With Our Professionals

With new updates concerning insurance and billing, we understand you may have concerns and questions you need answers to. At Versa Solutions, we’re always available to take your questions and provide you with practical answers that help solve your dental billing needs. 

Our goal remains to help you create a predictable cash flow so that you can focus on offering premium dental care without worrying about your A/R. We’ll help you navigate your billing systems to ensure you don’t miss out on cash flow. 

You can always reach out to us for any billing questions you have. We’re always happy to help!

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