INSURANCE COMPANIES, HEALTH SERVICE CORPORATIONS, MEDICAL SERVICE CORPORATIONS,
HOSPITAL SERVICE CORPORATIONS, HEALTH MAINTENANCE ORGANIZATIONS, DENTAL
SERVICE CORPORATIONS AND DENTAL PLAN ORGANIZATIONS ISSUING HEALTH BENEFIT
PLANS OR DENTAL PLANS IN NEW JERSEY
C. Bakke, Commissioner
||PROMPT PAYMENT OF CLAIMS REPORTING
REQUIREMENTS AT N.J.A.C. 11:22-1.9 AND BULLETIN 02-07
N.J.A.C. 11:22 establishes the Department of Banking and Insurance (Department)
standards for the prompt payment of claims relating to medical, hospital and
health service corporations, individuals and group health insurers, health maintenance
organizations, dental service corporations, dental plan organizations and prepaid
prescription service organizations, and any subsidiary of any of those entities
that processes health care benefit claims as a third party administrator in
N.J.A.C. 11:22-1.9 contains requirements for carriers to file certain reports
with the Department relating to the prompt payment of claims. On February 15,
2002, the Department issued Bulletin 02-07 clarifying these reporting requirements
based on inquiries received regarding the application of these rules. This Bulletin
provides additional guidance on the preparation and submission of the report
required by N.J.A.C. 11:22-1.9(b).
N.J.A.C. 11:22-1.9(a) requires that a carrier report to the Department on a
quarterly basis the timeliness of claims payments (Appendix A Report) and on
an annual basis the reasons for denial and late payment of claims. (Appendix
B Report). N.J.A.C. 11:22-1.9(b) requires that the annual report (Appendix B)
be audited. Bulletin 02-07 provided that the report of the auditing firm may
be filed with the Department on or before May 31, 2002.
The purpose of this Bulletin is to elaborate on the reporting requirements
for Appendix A and Appendix B:
- The report of the auditing firm is separate from the Appendix A and Appendix
B reports filed by the carriers. The report of the auditing firm is accompanied
by the annual report on the reasons for denial and late payment of claims
(Appendix B report). A report of the auditing firm is not required for the
quarterly report on timeliness of claims payment (Appendix A Report).
- The May 31, 2002 due date for the report of the auditing firm established
by Bulletin 02-07 is hereby extended to July 1, 2002. This filing shall consist
of the annual report (Appendix B), whether or not previously filed, and the
report of the auditing firm. The filing shall indicate (in the cover letter
or other transmittal document) whether the annual report (Appendix B) is (1)
identical to a report previously filed; (2) an amendment to a report previously
filed; or (3) the first such report filed.
- A Statement of Position 02-1, "Performing Agreed Upon Procedures Engagements
that Address Annual Claims Prompt Payment Reports as Required by the New Jersey
Administrative Code" satisfies the requirements of N.J.A.C. 11:22-1.9(b).
SOP 02-01 is available from the American Institute of Certified Public Accountants,
and may be obtained by calling 1-888-777-7077 and ordering product number
014934. The SOP also may be ordered by sending a fax to 1-800-362-5066, or
on-line at http://www.cpa2biz.com
- N.J.A.C. 11:22-1.9(b) requires that copies of the annual report (Appendix
B), accompanied by the report of the auditing firm, be sent to the Governor
and the majority and minority offices of the Legislature. This requirement
may be met by submitting three additional copies (a total of four copies)
to the Department for subsequent transmission.
- A request for an extension of time to file the report of the auditing firm
required by N.J.A.C. 11:22-1.9(b) shall be made by the carrier on or before
July 1, 2002. The request shall include the following: the reason for the
request; the date by which the report will be filed; and the name, address,
telephone number, FAX number and e-mail address of the person to be contacted
concerning the request. The Department cannot consider telephone or e-mail
extension requests. FAX requests shall be sent to 609-633-0527, Attn.: Prompt
- Requests for additional information and clarifications may be sent by FAX
to (609)-633-0527 Attn. Prompt Pay Reports. The telephone number for questions
regarding this Bulletin is 609-292-5427 Ext. 50340.
/s/ Holly C.
Holly C. Bakke