N.J. Admin. Code § 12:235-1.9

Current through Register Vol. 56, No. 11, June 3, 2024

Section 12:235-1.9 - Electronic medical bills for workers' compensation claims

(a) All workers' compensation healthcare providers, their billing representative, or any company that has purchased the right to pursue their bill, with the exception of those set forth under (g) below, shall submit complete electronic medical bills for payment using the American National Standards Institute (ANSI) Accredited Standards Committee (ASC) X12 837 National Standard.

(b) Employers, workers' compensation insurance carriers of employers, or workers' compensation third-party administrators shall accept electronic medical bills submitted for the payment of medical services under (a) above.

(c) Medical information submitted on electronic medical bills for payment of medical services shall be confidential, pursuant to the "Workers' Compensation Medical Information Confidentiality Act," sections 5 through 9 of P.L. 2001, c. 326 (N.J.S.A. 34:15-128.1et seq.).

(d) Employers, workers' compensation insurance carriers of employers, or workers' compensation third-party administrators shall acknowledge receipt of a complete electronic medical bill to the party that sent the complete electronic medical bill under (a) above.

(e) Payment for a complete electronic medical bill deemed by the employer, workers' compensation insurance carrier, or the workers' compensation third-party administrator to be compensable shall be paid within 60 days or less.

(f) Employers, workers' compensation insurance carriers for the employer, and their third-party administrators may exchange electronic data and establish payment deadlines through PPO or IPA contracts or agreements with health care providers or their billing representatives in a non-prescribed format or timeline, independent of the American National Standards Institute (ANSI) Accredited Standards Committee (ASC) X12 837 National Standard.

(g) This section shall not apply to any of the following providers:

1. One who submits less than 25 medical bills per month to employers, workers' compensation insurance carriers, or the workers' compensation third-party administrators;

2. One who furnishes services only outside of the United States;

3. One who experiences a disruption in electricity and communication connections that are beyond its control; or

4. One who demonstrates that a specific and unusual circumstance exists that precludes submission of electronic bills.

N.J. Admin. Code § 12:235-1.9

Adopted by 50 N.J.R. 1280(a), effective 5/21/2018