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Important information for AmeriHealth Pennsylvania professional providers

June 1, 2018

Effective for dates of service on or after September 1, 2018, AmeriHealth HMO, Inc. and its affiliates (AmeriHealth) will be making the following changes:

  • updating the standard medical and drug fee schedules for AmeriHealth Pennsylvania professional providers;
  • amending the AmeriHealth Pennsylvania Professional Provider Agreement to conform with contract language changes to our standard form Professional Provider Agreement.

To the extent that you are affected by these changes, AmeriHealth notified you via a postcard on June 1, 2018.

Resources

We have published the following resources related to the changes listed above on the NaviNet? web portal:

  • sample standard medical fee schedules (primary care physician and specialist) based on the most commonly billed CPT? codes by specialty;
  • standard professional drug, injectable, and vaccine fee schedule;
  • Fee Schedule and Advisory Amendment to your AmeriHealth Pennsylvania Professional Provider Agreement, as applicable.

To access these documents, go to AmeriHealth NaviNet Plan Central and select Resources from the Workflows menu.

If you have questions related to these changes, please email us at prvrequests@amerihealth.com with the subject line ?Professional Fee Schedule updates.? Make sure to include the practice name, NPI number, and your contact information. You will receive a response within five business days.

Note: This information does not apply to providers contracted with Magellan Healthcare, Inc.

NaviNet is a registered trademark of NaviNet, Inc.

CPT Copyright 2017 American Medical Association. All rights reserved. CPT? is a registered trademark of the American Medical Association.

Magellan Healthcare, Inc. manages mental health and substance abuse benefits for most AmeriHealth members.


This content was prepared for the Provider News Center and may not be reproduced in any way without the express written permission of AmeriHealth, AmeriHealth HMO, Inc., AmeriHealth Insurance Company of New Jersey.
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