Providers FAQs

Premier Access is a Managed Care Organization, meaning we have an agreement with the state of Utah to manage dental benefits for Utah Medicaid and CHIP members. In 2013, Guardian purchased Premier Access. Since Guardian was new to the government dental market at this time, they purchased Avesis in 2015, a nationwide expert in government dental, vision and hearing plan administration. Currently, Premier Access utilizes Avesis as a 3rd party administrator for Utah Medicaid and CHIP. While working with us, you may see a combination of Premier Access, Avesis and Guardian logos. Think of Premier Access and Avesis as siblings, and Guardian as their parent. Together, we work to provide the best service and care to our Utah Medicaid and CHIP providers and members.

As a participating provider, you will be nationally recognized on our provider directory. Listed practices typically see an increase in new patients when they become a participating provider.

Premier Access offers our providers simple administrative processes. You can submit claims, verify available benefits, and check claim status through our secure web portal. We pay promptly for services rendered, and there is no fee to join our network.

• Your practice will appear on our national provider directory.
• Our plan designs are easy to administer.
• Dedicated Provider support to respond to your inquiries.
• Our online and IVR tools are easy to use.
• Our customer service staff is knowledgeable and courteous.
• Clean claims have a speedy turnaround time.
• Electronic Payments (EFT).
• Online Provider Portal.

Click the link below, and one of our representatives will contact you shortly to help you with the application process and the agreements necessary for your state.

Send us a Message

Providers will be considered in-network and can treat Premier Access Medicaid/CHIP members when all of the following requirements are met:

• Obtain a Utah Medicaid Provider ID https://medicaid.utah.gov/become-medicaid-provider/
• If you have questions, please contact the Provider Enrollment Team at 1-800-662-9651. Press option 3, then option 4.
• Receive an approval from Guardian credentialing to the NCQA/government standard.
• Complete a CHIP and/or Medicaid contract agreement for your dental office.
• Contact customer service or your provider relations rep for more information.

• Premier Access utilizes centralized credentialing through our parent company, Guardian. Based on the networks you choose to join, your application will be reviewed at the appropriate credentialing standard.
• If you are already participating in the Guardian network, consult with your provider relations representative to see what steps are necessary to join Premier Access.

• Once Guardian receives all the necessary documents, the process should take approximately 45 days. When you are approved, you will receive a welcome letter with your effective date and more information.
• If any documents are missing or incomplete, this will delay the process and may cause your application to be denied.

Contact your Provider Services Representative for assistance.

Click the link below to send us your question, and we'll be in touch soon.

Send us a Message

• Member eligibility should be verified on the Utah State Look-Up Tool https://medicaid.utah.gov/eligibility/
• Or by calling Utah Medicaid at: 801-538-6155, select Access Now to verify eligibility.

CHIP and Medicaid members:
Should a member ask you or your office to render services that are not covered benefits, the member must consent in writing to the services and the cost of the services prior to treatment.

The consent must be in writing and include:

• The member’s willingness to accept non-covered procedures or treatments
• The member’s acknowledgement that s/he received notice that the procedure is not a covered benefit
• The member’s acknowledgement that s/he has been informed of the cost of the non-covered procedure or treatment
• Assurance that there are no covered benefits available to the member

PPO members:
See the members plan details for more information or call the provider services dept listed on the member ID card.

For Medicaid/CHIP:

• Member eligibility should be verified on the Utah State Look-Up Tool https://medicaid.utah.gov/eligibility/
• Or by calling Utah Medicaid at: 801-538-6155, select Access Now to verify eligibility

For Medicaid/CHIP:

• Member eligibility should be verified on the Utah State Look-Up Tool https://medicaid.utah.gov/eligibility/
• Or by calling Utah Medicaid at: 801-538-6155, select Access Now to verify eligibility

TTY calls are received and resolved using 7-1-1 or local relay services.

Our electronic claims submission and fund transfers are fast and easy. You'll appreciate the prompt and accurate adjudication and payment of clean claims, whether submitted electronically or on paper. Our process meets or exceeds federal or state prompt payment guidelines. Providers may submit claims to Premier Access through national clearinghouses, via the secure Premier Access Web Portal, or on paper claim forms.

To expedite processing, please include the approval code in Block 23 of the claim form.

Premier Access adheres to prompt pay laws as established in each state. Where no such law exists, clean claims are adjudicated within 30 days.

Corrected claims cannot be submitted electronically. Use the CMS 1500 claim form (vision and hearing) or ADA form (dental) with "CORRECTED CLAIM" at the top of the document, and mail it to the Premier Access claims department with all applicable information.

Premier Access Claims Department
P.O. Box 7777
Phoenix, AZ 85011-7777

As an Avesus provider, you have the right to appeal any claims that you believe have been paid incorrectly. Providers are always given the opportunity to submit any supporting documentation to be considered in the final determination. Please send all applicable information to the Claims Department address as noted above.

Download the Provider Change Form here and fax any changes to Premier Access Provider relations at (855) 896-0566.

When logging in for the first time to the updated Premier Access portal, providers must create a new and unique username and password that is specific to each provider ID/PIN and tax ID number combination. A default username of PIN and Tax ID for each location is no longer available.

You will need to select “Sign Up” from the Premier Access Vision login box. This will take you to a page to enter your TIN and your Premier Access PIN. This is the same TIN and PIN you previously used to log in.

Upon entering your TIN and PIN, you will be asked to create your account. Follow these steps to create the account:

• Select a provider associated with the location. This is the provider who will be linked to the account.
• Create a username and password.
• Set up your security questions. These security questions will be used to retrieve your password.
• Select “Create Credential.” Go back to the main provider page, and log in with your new username and password.

You can create one account for locations that have multiple providers! This will allow you to submit claims for all providers at that location. To create this feature, follow these steps:

• Select “Sign Up” from the Premier Access Vision login box.
• Enter your TIN and your Premier Access PIN. This is the same TIN and PIN you previously used to log in.
• Check the box next to “I am administering all providers’ claims in the service location” on the Create New Username and Password form.
• Enter the contact information for the person who will be administering the claims for that location.
• Verify that the service location entered matches the information for the location of the account.
• Ensure that the Office Name is showing in the area under “Select a provider in the location.”
• Create a username and password.
• Set up your security questions. These will be used to retrieve your password.
• Select “Create Credential.” Go back to the main provider page and log in with your new username and password.

Please call the Premier Access Customer Care team at (800) 828-9341 for further assistance.

Please contact our Customer Care team at (800) 828-9341 for further assistance to confirm that your account was created with the most up-to-date credentials to match our system.

Your account will automatically unlock 10 minutes after the account is locked. Once it is unlocked, you will be able to enter your username and password.

If you forget your password, simply click on “Forgot your password” in the login box. You will be asked to enter the username, first name, and last name associated with the account. The next page will ask you to answer the security questions that you set up when you first created your account. If you answer correctly, you will be asked to create a new password.

Please call Customer Care at (800) 828-9341 to retrieve your username.

Select Medicare/Medicaid in the login box on the Provider portal. Enter your username and password for your Medicare/Medicaid account, and click the “Log in to Medicare/Medicaid” box.

When submitting a claim, please be sure the user is capitalizing the H in all diagnosis codes and the V in all service codes. You must also remove the decimal from the diagnosis code. These adjustments should eliminate the error. Any claims with a date of service before 10/1/15 still require ICD 9 codes.