Effective January 1, 2019, 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 can look up the rate for a specific code using 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.
Note: The Allowance Inquiry transaction only returns current rates
for professional providers. The reimbursement rates that go into effect January
1, 2019, 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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