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 Independence NaviNet Plan Central, select Claim Inquiry and
Maintenance from the Independence 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 Network
Coordinator.
NaviNet is a registered trademark of NaviNet, Inc., an
independent company.