Healthcare Law Alert: Personal Injury Protection (PIP) Update

9/4/2019

Effective September 1, 2019, pursuant to N.J.S.A. 39:6A-5.4, all PIP providers are required to submit complete electronic medical bills for payment to insurance carriers or their third-party administrators.

A complete electronic medical bill is defined by N.J.S.A. 39:6A-5.3 as:

• Submitted in the correct uniform billing format, with the correct uniform billing code sets, transmitted in compliance with the guidelines;
• The bill and electronic attachments provide all information required under the guidelines established by this act; and
• The healthcare provider or its billing representative has provided all information that the insurance carrier or its third party administrator requested.

Pursuant to N.J.S.A. 39:6A-5.5, this statute does not apply those that:

• Submit less than 25 medical bills per month to insurance carriers or third-party administrators;
• Furnish services only outside of the United States;
• Experience a disruption in electricity and communication connections that are beyond its control; or
• Demonstrate that a specific and unusual circumstance exists that precludes submission of electronic bills.

It is advised that PIP providers check with all insurance carriers regarding where/how the electronic bills should be submitted.

If you have any questions about the information contained in this Health Law Alert, please contact:
Keith J. Roberts│973.364.5201│kroberts@pagconcepts.com
Colleen Buontempo│973.364.5210│cbuontempo@pagconcepts.com