Effective for dates of service on or after December 1, 2020, AmeriHealth HMO, Inc. and AmeriHealth Insurance Company of New Jersey (collectively, AmeriHealth New Jersey) will be adjusting the base reimbursement rate for primary care physicians (PCP) and specialists.

AmeriHealth New Jersey mailed a notification on September 1, 2020, to providers who are affected by these changes.

Next steps

• Review your provider roster. Practices that receive the mailing should review the roster included with the letter. If roster changes are needed, log onto the NaviNet^® web portal (NaviNet Open), select AmeriHealth from the Health Plans/My Plans menu, then Provider File Management from the Workflows menu.
• Request sample fee schedules. Fee schedule samples for PCPs and specialists are available based on the most commonly billed CPT^® codes by specialty. You can request a copy of the sample fee schedule by sending an email to AHNJContracting@amerihealth.com with the subject line: “AHNJ Professional Fee Schedule updates (12/1/20)." Please include your tax ID, NPI, specialty, and contact information in the request.
• Review rates. Use the Allowance Inquiry transaction on NaviNet Open to look up rates for specific codes. To do so, 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 Allowance Inquiry Guide, which is available under User guides and webinars in the NaviNet Open section.

Questions

If you have any questions regarding these fee schedule revisions, please call Customer Service at 1-888-YOUR-AH1 (1-888-968-7241).

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