AvMed Physician

Benefit
Coordination
Ninety-eight percent of AvMed physicians find it easy to obtain referrals and authorizations.
Benefit Coordination Team
Each regional office is comprehensively supported by the Benefit
Coordination Team, a highly trained clinical and administrative staff.
When a request is submitted for authorization, an AvMed Medical
Director and the Benefit Coordination Team will provide consistent
application of internal procedures/guidelines, nationally recognized
criteria and administration of benefit limitations. These initiatives
can be best accomplished by coordinating your clinical expertise
with the clinical and cost management know-how of the AvMed
Medical Directors and Benefit Coordination Team.
AvMed’s authorization process has been designed to achieve and
sustain coordinated and efficient service for AvMed members.
This process also allows AvMed to identify and enroll members in
pre-planned discharge planning (Speedy Recovery) and specialized
programs, such as Disease and Case Management.
The Benefit Coordination Team constantly strives to enhance
the partnership with your office via a commitment to enhanced
teamwork, effective communication and first-class customer
service. Their goal is to provide you and AvMed Members — your
patients — with high-quality and cost-effective care.
Authorizations
Authorizations for simple referrals/consultations to participating
specialists, as well as for most services provided in a
participating physician’s office, are not required; however, a
referral is required by select plans. AvMed values the role of the
Primary Care Physician (PCP) and requires that most members
select a PCP. We expect that the PCP will continue to play the same
integral role with our members by coordinating their medical care
with specialists and other health care providers.
6 • AvMed Physician Orientation Manual