New Jersey Administrative Code
Title 11 - INSURANCE
Chapter 22 - HEALTH BENEFIT PLANS
Subchapter 1 - PROMPT PAYMENT OF CLAIMS
Section 11:22-1.9 - Reimbursement of underpaid claims
Universal Citation: NJ Admin Code 11:22-1.9
Current through Register Vol. 56, No. 24, December 18, 2024
(a) No health care provider shall request reimbursement from a health carrier or its agent or from a covered person later than 18 months from the date the first payment on the claim was made unless the claim is the subject of an internal appeal pursuant to 11:22-1.10 or is subject to continual claims submission.
1. The written reimbursement request shall be
a separate notice to the health carrier or its agent or the covered person and
shall include:
i. A clear identification of
the claim;
ii. The name of the
health care provider's patient and the date of service; and
iii. An explanation of the basis upon which
the health care provider believes the amount paid on the claim was less than
the amount due.
2. No
health care provider shall seek more than one reimbursement for underpayment of
any particular claim from a health carrier or its agent or from a covered
person.
Disclaimer: These regulations may not be the most recent version. New Jersey may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
This site is protected by reCAPTCHA and the Google
Privacy Policy and
Terms of Service apply.
