Medicaid & Medicare Advantage Services for States & Health Plans

Operations

Every aspect of our work is driven by our three corporate values: do the right thing, people count, and we hold ourselves to high standards. This is particularly true for our government operations team, made up of nearly 550 U.S.-based employees who manage core administrative functions like claims processing, utilization review, multi-lingual contact center, and HIPAA-compliant portals.

Clinical

We do the right thing, which means managing dental and eye care benefits to help ensure your  members achieve optimal health. Every day, licensed clinicians in the office and in the field help ensure the care your members receive is compliant with state and federal standards, as well as your benefit plans and clinical goals.

Network

The success of the Medicaid and Medicare Advantage programs we help manage is built on the strength of our provider networks. All are fully compliant with state and federal requirements for government programs, meeting credentialing, access, and appointment standards. With our commercial networks as our starting point, we can build networks in all 50 states.

See Who We Serve with Medicaid & Medicare Advantage Programs

Medicaid and Medicare Advantage dental and eye care services are managed by our wholly owned subsidiary Avēsis in collaboration with our wholly owned subsidiaries Premier Access Insurance Company and Access Dental Plan. These teams came together in 2017 to create a simplified operational model staffed by dedicated leaders who have an average of more than 20 years of market experience.

Today we efficiently manage care for more than 7.5 million covered lives through our contracts with states and health plans. Our team helps ensure our clients meet their regulatory obligations, while satisfying network providers, reducing costs, and contributing to the improvement of the country's overall health.

Explore Our Impact in Medicaid & Medicare Advantage

When we ask our state and health plan clients how we can help, they tell us:

  • Engage members in their own care
  • Satisfy network dentists and eye health providers
  • Reduce government healthcare costs
  • Improve oral, ocular, and overall health

These activities make up the Quadruple Aim, a framework we use to build government healthcare programs that help you improve the health of your enrollees and their communities.  

Discover Our Innovative Medicaid & Medicare Advantage Value-Add Programs

We put people first—from members to providers—to coordinate quality care that can be simple to administer and can help lower overall costs. With 25 years of experience in the government dental and eye care markets, we’ve developed innovative ways to connect enrollees to care, facilitate treatment of complications of diabetes, and expand access for underserved populations. These programs help us help our clients engage members, satisfy providers, save money, and improve overall health.

Disclaimer

Medicaid, CHIP, and Medicare Advantage dental, eye care, and hearing care programs are made available through government contracts awarded to Guardian or its subsidiaries. These contracts are administered by Avēsis Third Party Administrators, Inc., for Guardian. Avēsis is a wholly owned subsidiary of Guardian. Guardian® is a registered trademark of The Guardian Life Insurance Company of America, New York, NY.

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