Beginning January 1, 2012, an
expanded list of services eligible for separate reimbursement above capitation
for HMO/POS products will be implemented for New Jersey primary care physicians
(PCP) who are reimbursed on a capitated basis. This new expanded list includes
the following services:
To view a complete list of services
that are currently eligible for separate payment above the monthly PCP
capitation fee, please see Attachment B to Claim Payment Policy #00.10.01o:
Services Paid Above Capitation for Health Maintenance Organization (HMO)
Primary Care Physicians, which is available by entering the policy number in
the Search box on our medical policy website at www.amerihealth.com/medpolicy.
If you have any questions regarding
this update, please contact your Network Coordinator.