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Effective July 1, 2014, positive changes will be made to
the AmeriHealth HMO, Inc. and its affiliates
(?AmeriHealth?) standard fee schedule for certain professional providers..
The following reimbursement changes under your current Professional Provider
Agreement with AmeriHealth will
be effective July 1, 2014, for services provided to HMO, POS, and PPO members
enrolled in commercial Benefit
Programs:
- Monthly PCP capitation. For commercial HMO and POS
Benefits Programs, we are increasing the monthly
capitation rates for primary care physicians (PCP) who are reimbursed on a
capitated basis by 3.0 percent in
aggregate. A larger percentage of the Per Member Per Month rate increase will
be applied to those members
with higher copayments; therefore the increase at a practice level will
vary.
- Professional commercial services. For all commercial
Benefit Programs, we are updating our fee
schedule to increase Evaluation & Management codes for new, established, and
preventive care office visits
(CPT® 99201 ? 99215, 99381 ? 99397) billed by your specialty.
These codes will be increased 3.0 percent;
however, the aggregate increase at a practice level will vary based on the mix
of services you provide.
For more information
For your reference, we have published a summary of the fee schedule changes
by provider type on
AmeriHealth NaviNet Plan Central. To access these documents, select
AmeriHealth from the Plan Central
drop-down menu, and then refer to the Administrative Tools & Resources
section.
If you have any questions regarding these fee schedule changes, please call
us at 1-888-289-3039 and leave a
detailed message. Include your name, contact number, provider number, and the
best time for us to call. You will
receive a return call within two business days.
Note: This information does not apply to providers contracted with
Magellan Behavioral Health, Inc.
NaviNet® is a registered trademark of
NaviNet, Inc.
CPT copyright 2012 American Medical Association. All
rights reserved. CPT is a registered trademark of the American Medical
Association.
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