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Home > Insurance Division > Claims Payment Dispute Arbitration > Selected Arbitration Decisions
Selected Arbitration Decisions


The New Jersey Program for Independent Claims Payment Arbitration (PICPA) is a program established by the Health Claims Authorization, Processing and Payment Act (HCAPPA), P.L. 2005, c. 352, designed to provide health care providers and carriers offering health benefits plans an independent body able to arbitrate claims disputes between a payer and health care provider.  The Department of Banking and Insurance contracts with an independent vendor, MAXIMUS, Inc., to perform the arbitration and related administrative functions.

Below are selected arbitration decisions, with confidential information redacted.

 

Arbitration# NJ07-0255 (PDF)
Date of Decision: 1/10/2008
Provider Status: Non-participating
Type of Plan: Small Employer
Date of Service: 5/22/2007
Procedure at Issue: Facility fees - CPT code 29873-59 and 29879
Billed Amount: $6,266.70 and $8,194.82
Paid Amount: $305.70 and $305.70
Award: Additional reimbursement of $5,961 and $7,011.30, plus 12% interest

Arbitration# NJ07-0278 (PDF)
Date of Decision: 1/29/2008
Provider Status: Non-participating
Type of Plan: Small Employer
Date of Service: 10/31/2006
Procedure at Issue: CPT codes 15770, 63030 and 69990
Billed Amount: $3,862, $9,758 and $3,993
Paid Amount: $1,414.50, $8,000 and $0
Award: None - additional reimbursement not warranted
 
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