Effective April 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.
Note: The Allowance Inquiry transaction returns current rates for
professional providers only. The reimbursement rates that go into effect April
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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