Professional Injectable and Vaccine Fee Schedule updates effective January 1, 2021

December 1, 2020

Effective January 1, 2021, updates will be made to our Professional Injectable and Vaccine Fee Schedule for all contracted providers. These updates are made quarterly and reflect changes in market price (i.e., average sales price [ASP] and average wholesale price [AWP]) for vaccines and injectables as well as any modifications to the percentage premium.

Allowance Inquiry transaction

Providers may find the rate for a specific code using the Allowance Inquiry transaction on the NaviNet® web portal (NaviNet Open). To do so, go to AmeriHealth NaviNet Open Plan Central, select Claim Inquiry and Maintenance from the AmeriHealth Workflows menu, and then select Allowance Inquiry. For step-by-step instructions on how to use this transaction, refer to the Allowance Inquiry Guide, which is available under User guides and webinars in the NaviNet Open section.

The Allowance Inquiry transaction only returns current rates for professional providers. The reimbursement rates that go into effect January 1, 2021, will be available through this transaction on or after this effective date. Provider payment allowances are for informational purposes only and are not a guarantee of payment.

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