As communicated in the December 2011 edition of Partners in Health Update^SM, 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. However, the CPT? codes listed for subsequest observation care were incorrect and have been updated in the chart below.

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 at www.amerihealth.com/medpolicy.

If you have any questions regarding this update, please contact your Network Coordinator.

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