Effective January 1, 2017, we will implement a quarterly
update to our Professional Injectable and Vaccine Fee
Schedule for all contracted providers. These updates reflect changes in market
price (i.e., average sales price [ASP]
and average wholesale price [AWP]) for vaccines and injectables and
modifications to the percentage premium for the
following:
| Drug | Code | Narrative |
|---|
| Actemra® | J3262 | Injection, tocilizumab, 1 mg |
| Entyvio® | J3380 | Injection, vedolizumab, 1 mg |
| Inflectra™ | Q5102
| Injection, infliximab, biosimilar, 10 mg |
| Orencia® | J0129
| Injection, abatacept, 10 mg |
| Remicade® | J1745
| Injection, infliximab, 10 mg |
| Simponi® Aria™ | J1602 |
Injection, golimumab, 1 mg, for intravenous use |
| Stelara® | J3357
|
Injection, ustekinumab, 1 mg |
Allowance Inquiry transaction
To look up the rate for a specific code, use the Allowance Inquiry
transaction on the NaviNet® web portal. To do so, go
to AmeriHealth NaviNet 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 user guide
available in the NaviNet Resources section of our
Provider News Center.
Note: The Allowance Inquiry transaction returns current rates for
professional providers only. The reimbursement rates
that go into effect January 1, 2017, 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.
If you have any questions about these updates, please contact your Provider
Partnership Associate or
Network Coordinator.
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