N.J. Admin. Code § 11:22-1.9

Current through Register Vol. 56, No. 21, November 4, 2024

Section 11:22-1.9 - Reimbursement of underpaid claims

(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.

N.J. Admin. Code § 11:22-1.9

Amended and recodified from 11:22-1.10 by 50 N.J.R. 571(a), effective 1/16/2018

Adopted by 50 N.J.R. 829(a), effective 2/5/2018