Primary Care Rate Increase

Rate Increase for Certain Primary Care Services and Provider Specialties

Under the Affordable Care Act, HealthKeepers, Inc.’s reimbursement for certain primary care services furnished by eligible providers to its Anthem HealthKeepers Plus Medicaid managed care members in calendar years 2013 and 2014 must be based on Medicare rates. Primary care services eligible for the payment increase include:

  • Evaluation and management (E&M) procedure codes between 99201 and 99499
  • Vaccine and toxoid administration procedures

Eligible providers are physicians, nurse practitioners and physician’s assistants working under the personal supervision of a physician with a specialty designation of family medicine, general internal medicine, or pediatric medicine or related subspecialty. The increased reimbursement does not apply to services provided to FAMIS enrollees.

Physicians eligible for the primary care rate increase are required to complete the Certification and Attestation for Physician Primary Care Rate Increase form and submit via fax to 804-354-4601.


Certification and Attestation for Physician Primary Care Rate Increase Form

Physicians must self-attest to a specialty designation of family medicine, general internal medicine, and/or pediatric medicine and/or subspecialty and one of the following criteria below to receive the higher reimbursement for eligible primary care services:

  • Board-certified physician with a specialty designation of family medicine, general internal medicine, and/or pediatric medicine or a related subspecialty recognized by the American Board of Medical Specialties (ABMS), American Board of Physician Specialties (ABPS), American Osteopathic Association (AOA)or the American Board of Allergy and Immunology (ABAI).
  • Approximately 60 percent of the Medicaid codes billed during the most recently completed calendar year or the prior month for newly eligible physicians were for evaluation and management (E&M) procedure codes between 99201 and 99499 and vaccine and toxoid administration procedures.

To self-attest, access the Certification and Attestation for Physician Primary Care Rate Increase Form .


Forms processing and additional information

All physicians who self-attest on or before March 31, 2013, will be eligible for the higher payments for dates of service on or after January 1, 2013. On or after April 1, 2013, physicians will be eligible for higher reimbursement for dates of service on or after the beginning of the month of self-attestation.