Effective March 1, 2022, AmeriHealth HMO, Inc., and its affiliates (AmeriHealth) will adjust the base reimbursement rate for primary care physicians (PCP) and specialists who provide services to our members.

What is changing?

Collectively, the rates updates are positive for the provider network. The impact to each physician will depend on the most commonly billed CPT^® codes by specialty.

Where to find your new rates?

Starting on March 1, 2022, you can find the rate for a specific code using the Allowance Finder transaction in the PEAR Practice Management (PM) application on the Provider Engagement, Analytics & Reporting (PEAR) portal.

• From PEAR PM, select Allowance Finder from the Transactions menu under the Provider Payment section.
• If your organization is not registered for PEAR, visit this page to learn more.

Resources

We have posted resources related to the upcoming changes on PEAR PM:

• Sample fee schedules: Sample standard medical fee schedules (PCP and specialist) can be found using the Reference icon. Select the Generic Fee Schedule link.
• Fee Schedule and Advisory Amendment: Click here to view a contract amendment that addresses the Consolidated Appropriations Act and No Surprises Act.

If you have questions about these changes, please email us 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.

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