Reimbursement Information
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Links to Prompt Pay, HCAPPA & Medical Necessity Resources
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- N.J.A.C. 11:22-Subchapter 5. Minimum Standards for Health benefit Plans, Prescription Drugs and Dental Plans
- 2008 NJ Dept. of Banking and Insurance, Division of Insurance, Health Benefit Plans, Minimum Standards for Network-Based Health Benefit Plans, Proposed Amendments: N.J.A.C. 11:22-5.2 through 5.9 and Proposed New Rules: N.J.A.C. 11:22-5.5 and 5.6
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New Jersey Department of Banking and Insurance (NJDOBI) - Website Homepage
http://www.state.nj.us/dobi/index.html
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New Jersey Legislature - P.L. 2005, c. 352 (The Health Claims Authorization Processing and Payment Act (HCAPPA)
http://www.njleg.state.nj.us/2004/Bills/PL05/352_.HTM
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NJDOBI - HCAPPA General Info
http://www.state.nj.us/dobi//chap352/352implementnotice.html
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NJDOBI Bulletin 06-16 RE: - P.L. 2005, c. 352 - HCAPPA Forms, Effective Date and an Update on Arbitration.
- Consent and Authorization (for Utilization Management Appeals and Arbitration);
- Notice of Revocation of Consent (for Utilization Management Appeals);
- Application to Appeal a Claims Determination
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http://www.state.nj.us/dobi/bulletins/blt06_16.pdf
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Consent to Representation in Appeals of Utilization Management Determinations and Authorization for Release of Medical Records in Utilization Management (UM) Appeals and Independent Arbitration of Claims
http://www.state.nj.us/dobi/chap352/352consentform.doc
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Health Care Provider Application to Appeal a Claims Determination
http://www.state.nj.us/dobi/chap352/352application.doc
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NJDOBI - Bulletin 06-17 RE: - P.L. 2005, c. 352 - HCAPPA Forms
- Independent Health Care Appeals Program Application
- Notices of Intent to File a UM Appeal
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http://www.state.nj.us/dobi/bulletins/blt06_17.pdf
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FAQ - Claims Payment: Prompt Payment of Claims Issues
http://www.state.nj.us/dobi/chap352/352claimsqanda.html
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NJDOBI Bulletin 07-04 RE: - P.L. 2005, c. 352 HCAPPA - Arbitration Program
http://www.state.nj.us/dobi/bulletins/blt07_14.pdf
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FAQ - Claims Payment: Claims Handling Appeals and the Program for Independent Claims Payment Arbitration (PICPA)
http://www.state.nj.us/dobi/chap352/352appealqanda.html
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Program for Independent Claims Payment Arbitration (PICPA) -MAXIMUS website
https://njpicpa.maximus.com/web/provider
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FAQ - Utilization Management: Initial Determinations, Staffing and Readily Accessible Information
http://www.state.nj.us/dobi/chap352/352uminitialqanda.html
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FAQ - Utilization Management: UM Appeals and the Independent Health Care Appeals Program (IHCAP)
http://www.state.nj.us/dobi/chap352/352umappealsqanda.html
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How to File a Utilization Management Appeal
http://www.state.nj.us/dobi/division_insurance/managedcare/umappeal.htm
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DOBI Form /Stage 1 - Notice of Intent to Appeal an Adverse UM Determination
http://www.state.nj.us/dobi/chap352/352noticesf1.doc
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DOBI Form /Stage 2 - Notice of Intent to Appeal an Adverse UM Determination
http://www.state.nj.us/dobi/chap352/352noticesf2.doc
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DOBI Form / Stage 3 - Notice of Intent to Appeal an Adverse UM Determination
http://www.state.nj.us/dobi/chap352/352noticesf3.doc
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Independent Health Care Appeals Program (IHCAP)
http://www.state.nj.us/dobi/division_insurance/managedcare/ihcap.htm
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IHCAP Application Form
http://www.state.nj.us/dobi/chap352/352ihcapform.doc
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Managed Care Provider Rights and Responsibilities
http://www.state.nj.us/dobi/division_insurance/managedcare/mcprovrights.htm
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Managed Care Complaints, Frequently Asked Questions and Definitions (with Complaint Forms)
http://www.state.nj.us/dobi/division_insurance/managedcare/mcfaqs.htm
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Insurance Complaint Form Available on-line or PDF
http://www.state.nj.us/dobi/complain.pdf
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DOBI - Bulletin 10-36 RE: Assignment of Health Benefits Under Managed Care Plans
http://www.state.nj.us/dobi/bulletins/blt10_36.pdf
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