N.J. Admin. Code § 11:22-9.3

Current through Register Vol. 57, No. 1, January 6, 2025

Section 11:22-9.3 - General requirements

(a) Obstetrical providers may elect to be reimbursed for maternity services rendered to a covered person on either a global basis (one payment for all services rendered during the term of a covered person's pregnancy for antepartum care, delivery and postpartum care) or on an installment basis (more than one payment for services rendered during the term of a covered person's pregnancy).

(b) Carriers shall permit providers to elect at least annually whether to be reimbursed for maternity services on a global or an installment basis. Such election shall be made in writing and take effect with respect to pregnancies beginning on or after 30 days following receipt of notice by the carrier. Written notice of the provider's election may be effectuated via mail, fax, e-mail or web-based provider portal.

(c) Providers shall be permitted to opt out of their initial election to be reimbursed in installments at any time within the first year following that election and annually thereafter for any given provider taxpayer identification number. Carriers may require that the election change be in writing. Carriers shall not defer application of the change more than 30 days following receipt of the election change.

(d) Any such election as described in (b) or (c) above shall be made with respect to all providers billing under the same provider identification number unless otherwise agreed to by the provider and the carrier.

(e) In the absence of an installment election, carriers shall reimburse providers billing for services rendered on a global basis based on billings actually received, subject to the carrier's reasonable requests for medical records and other documentation necessary to establish the appropriate payment.

N.J. Admin. Code § 11:22-9.3