New Jersey Administrative Code
Title 13 - LAW AND PUBLIC SAFETY
Chapter 30 - NEW JERSEY BOARD OF DENTISTRY
Subchapter 8 - GENERAL PROVISIONS
Section 13:30-8.10 - Third-party payor records
Current through Register Vol. 56, No. 6, March 18, 2024
(a) No licensee shall submit any claim, bill or govern-mental assistance claim to a third party payor for dental services rendered to any patient which involves dishonesty, fraud, deception or misrepresentation.
(b) No licensee shall submit to a third-party payor any claim, bill, or governmental assistance claim that contains any of the following:
(c) A licensee who renders dental services or procedures to a patient enrolled in any dental plan with co-payment features and who intends to waive any part of the co-payment or all of the co-payment by the patient shall, when submitting any claim or bill to the third party payor, conspicuously disclose on the face of the claim or bill in a legible manner, or in the electronic claim submission, that the co-payment, or a portion of the co-payment, shall not be billed to, or collected from, the patient.
(d) The accuracy of all information contained in written or electronic submissions to a third-party payor including predeterminations, claims, bills, or governmental assistance claims, shall be the personal responsibility of the licensee whose name, license number, or signature appears on the signature line of the claim. In the case of electronic claims, the licensee identified as the provider shall be held responsible for the accuracy of the information whether or not the licensee actually completed the claim. The Board shall presume that the licensee identified on the claim reviewed its contents and approved its submission.
(e) All third-party payor records shall be maintained pursuant to the provisions of N.J.A.C. 13:30-8.7 or be readily retrievable.