News
Fee Schedule Changes
Date: 09/28/15
On September 10th we mailed a letter regarding changes to the fee schedule for our Health Insurance Marketplace product, Ambetter. The effective dates listed in the letter were incorrect. Please refer to this notice for the correct information on this topic.
For Ambetter providers using the Ambetter Payor Medicare Fee Schedule, effective January 1, 2016, we will update our baseline fee schedule from 2012 Medicare Relative Values (RVUs) to 2015 Medicare RVUs. These values will remain fixed for a three-year period, with quarterly updates to accommodate the addition of newly valued billing codes and changes in reimbursement.
Effective November 1, 2015, we will incorporate of additional CMS fee schedules to our reimbursement methodology. Ambetter’s base fee schedules previously relied on the RVUs developed by CMS. We will include additional CMS base schedules (e.g., laboratory, durable medical equipment, ambulance, etc.) to fully reflect the range of services being provided to our members.
Providers who are on the Current Medicare Fee Schedule will not experience any changes.
If you have any questions or concerns, please reach out to your Provider Relations representative.