NJ Admin Code § 11:24-8.3(c)(1)(i)
October 15, 2021 5:17 am(c) All determinations shall be made on a timely basis, as required by the exigencies of the situation. (1) An... View more
(c) All determinations shall be made on a timely basis, as required by the exigencies of the situation. (1) An... View more
(a) A carrier and its agent shall remit payment of clean claims pursuant to the following time frames: (1) Thirty... View more
(2) For determinations, a health carrier shall make the determination within thirty-six hours, which shall include one working day, of... View more
(6)(1) If the health carrier has not paid the claimant on or before the forty-fifth processing day from the date... View more
(1) Each entity offering individual and group health insurance policies providing coverage on an expense-incurred basis, individual and group service... View more
(2) Any medical director who administers the utilization review program or oversees the review decisions shall be a qualified health... View more
(1) A health carrier shall cover emergency services necessary to screen and stabilize an enrollee, as determined by the treating... View more
(4) When an enrollee receives an emergency service that requires immediate post evaluation or post stabilization services, a health carrier... View more
ASK YOURSELF: What date was the claim initially billed? Was there any written communication (request for information, denial, underpayment) from... View more
ASK YOURSELF: Who denied the claim? What is the professional’s license number with the State Medical Board? Were they a... View more